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General NPI Number Information
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NPI Number | 1295560977
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Entity Type | Organization
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Legal Business Name | RENEWAL ROOM LLC
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 392 JEFFERSON POINT
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City | ROAMING SHORES
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State | OH
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Zip | 44084
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Country | US
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Telephone | 440-290-9207
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Fax |
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Provider Business Mailing Address
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Address Line | 7554 FREDLE DR UNIT 3006
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City | CONCORD TOWNSHIP
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State | OH
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Zip | 44077-9406
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Country | US
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Telephone | 440-290-9207
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA FISHER CROSS
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Credential | LISW-SUPV
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Telephone | 440-202-9109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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