Healthcare Provider Details

I. General information

NPI: 1740116607
Provider Name (Legal Business Name): RENEW RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 ROCKSIDE RD
PARMA OH
44134-2767
US

IV. Provider business mailing address

1157 ROCKSIDE RD
PARMA OH
44134-2767
US

V. Phone/Fax

Practice location:
  • Phone: 440-879-1258
  • Fax:
Mailing address:
  • Phone: 440-879-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL PETRICK
Title or Position: TAX ID OWNER
Credential: CNP
Phone: 440-879-1258