MEDICARE: RENEW- REINVENTING EDUCATION

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	251300000X	Local Education Agency (LEA)		LA

General Provider Information

NPI Number	:	1912276510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW- REINVENTING EDUCATION

Provider Business Mailing Address
First Line	:	3128 CONSTANCE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-2337
Country	:	US
Telephone Number	:	504-444-3251
Fax Number	:

Provider Business Practice Location Address
First Line	:	3128 CONSTANCE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-2337
Country	:	US
Telephone Number	:	504-444-3251
Fax Number	:

Authorized Official
Title or Position	:	SPECIAL PROGRAMS COORDINATOR
Name	:	MS. BROOKE GERSHMAN
Credential	:
Telephone Number	:	504-444-3251

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	12/28/2011

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