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General NPI Number Information
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NPI Number | 1720562929
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Entity Type | Organization
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Legal Business Name | RENEWED AGING SERVICES, INC
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 4320 WINFIELD RD STE 200
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City | WARRENVILLE
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State | IL
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Zip | 60555-4023
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Country | US
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Telephone | 630-432-1170
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 KYLEMORE CT
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City | LOCKPORT
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State | IL
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Zip | 60441-2678
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Country | US
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Telephone | 815-685-1064
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JASON MORRIS
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Credential | PSYD
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Telephone | 815-685-1064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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