Healthcare Provider Details

I. General information

NPI: 1225280209
Provider Name (Legal Business Name): RENU TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 N 1200 W
OREM UT
84057-3525
US

IV. Provider business mailing address

774 N 1200 W
OREM UT
84057-3525
US

V. Phone/Fax

Practice location:
  • Phone: 801-765-7528
  • Fax: 801-765-7532
Mailing address:
  • Phone: 801-765-7528
  • Fax: 801-765-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MELODY SARGENT ASHMAN
Title or Position: OWNER
Credential:
Phone: 801-765-7528