MEDICARE: RENEWED LIFE TREATMENT CENTER. INC

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	251B00000X	Case Management Agency		CA

General Provider Information

NPI Number	:	1154578904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED LIFE TREATMENT CENTER. INC

Provider Business Mailing Address
First Line	:	1855 E COLORADO BLVD
Second Line	:	BLDG. B
City	:	PASADENA
State	:	CA
Zip	:	91107-3554
Country	:	US
Telephone Number	:	626-793-0519
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 E COLORADO BLVD
Second Line	:	BLDG. B
City	:	PASADENA
State	:	CA
Zip	:	91107-3554
Country	:	US
Telephone Number	:	626-793-0519
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. STELLA OGBEIDE
Credential	:	RN
Telephone Number	:	626-793-0519

Provider Enumeration Date	:	08/23/2008
Last Update Date	:	11/19/2009

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