MEDICARE: RENEWED HOPE BEHAVIORAL HEALTH PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW012617	PA
2	104100000X	Social Worker	SW013618L	PA
3	2084P0800X	Psychiatry Physician	OS008623L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053365015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED HOPE BEHAVIORAL HEALTH PC

Provider Business Mailing Address
First Line	:	PO BOX 348
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-0348
Country	:	US
Telephone Number	:	724-458-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 WOODLAND CENTER DR
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-4677
Country	:	US
Telephone Number	:	724-458-0811
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LINDA ZULOVICH
Credential	:	D.O.
Telephone Number	:	724-458-0811

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	05/30/2008

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