Healthcare Provider Details

I. General information

NPI: 1407746233
Provider Name (Legal Business Name): BLACKROCK RENEWAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1294 EAST AVE
AKRON OH
44307-1402
US

IV. Provider business mailing address

424 W THORNTON ST
AKRON OH
44307-1967
US

V. Phone/Fax

Practice location:
  • Phone: 330-573-5759
  • Fax: 330-573-5759
Mailing address:
  • Phone: 330-573-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DENILLE MCCRAY
Title or Position: MEMBER
Credential:
Phone: 330-573-5759