Healthcare Provider Details

I. General information

NPI: 1407770548
Provider Name (Legal Business Name): RENEW360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 ROUTE 37 W
TOMS RIVER NJ
08755
US

IV. Provider business mailing address

432 LAKEHURST RD STE 2
TOMS RIVER NJ
08755-7333
US

V. Phone/Fax

Practice location:
  • Phone: 732-234-0058
  • Fax: 848-317-8309
Mailing address:
  • Phone: 732-234-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AIDA M ALBINO-WIMBUSH
Title or Position: LPC
Credential:
Phone: 609-858-8643