Healthcare Provider Details

I. General information

NPI: 1215744628
Provider Name (Legal Business Name): RENEW BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23611 CHAGRIN BLVD
BEACHWOOD OH
44122-5540
US

IV. Provider business mailing address

71 HALLEY DR
POMONA NY
10970-2108
US

V. Phone/Fax

Practice location:
  • Phone: 888-442-2323
  • Fax:
Mailing address:
  • Phone: 718-213-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEAH NEIMAN
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 216-373-3122