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General NPI Number Information
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NPI Number | 1831330356
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Entity Type | Organization
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Legal Business Name | RENU LIFE, LLC
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 1206 N BERKELEY BLVD STE L
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City | GOLDSBORO
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State | NC
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Zip | 27534-3476
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Country | US
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Telephone | 919-734-0266
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Fax |
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Provider Business Mailing Address
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Address Line | 501 FOREST HILL DR
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City | GOLDSBORO
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State | NC
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Zip | 27534-1824
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DIANE HARRISON
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Credential |
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Telephone | 919-734-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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