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General NPI Number Information
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NPI Number | 1255224226
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Entity Type | Organization
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Legal Business Name | RENEW LIFE OUT-PATIENT RECOVERY CENTER LLC
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 110 MAYCOX AVE STE 6
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City | NORFOLK
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State | VA
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Zip | 23505-3433
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Country | US
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Telephone | 757-991-1481
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Fax |
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Provider Business Mailing Address
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Address Line | 110 MAYCOX AVE STE 6
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City | NORFOLK
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State | VA
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Zip | 23505-3433
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Country | US
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Telephone | 757-991-1481
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ORNA HUNTER-MOOREHEAD
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Credential |
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Telephone | 757-513-2262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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