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General NPI Number Information
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NPI Number | 1437969482
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Entity Type | Organization
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Legal Business Name | RENEWAL RECOVERY HOUSE LLC
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Dates
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Enumeration Date | 01/11/2025
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 15398 W BADEN ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-1663
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Country | US
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Telephone | 520-280-8009
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Fax |
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Provider Business Mailing Address
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Address Line | 15398 W BADEN ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-1663
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Country | US
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Telephone | 520-280-8009
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. GLORIA J HARRIS
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Credential | LISAC, LAC
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Telephone | 520-280-8009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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