=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407770548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENEW360
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2026
-----------------------------------------------------
Last Update Date | 08/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1181 ROUTE 37 W
-----------------------------------------------------
City | TOMS RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-234-0058
-----------------------------------------------------
Fax | 848-317-8309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 432 LAKEHURST RD STE 2
-----------------------------------------------------
City | TOMS RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08755-7333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-234-0058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPC
-----------------------------------------------------
Name | AIDA M ALBINO-WIMBUSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-858-8643
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------