| Life Renewal Services, Inc. | |
|
247-249 East Main Street Westminster MD 21157-5228 | |
| (410) 289-8149 | |
| (443) 821-3280 |
| Full Name | Life Renewal Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 247-249 East Main Street, Westminster, Maryland |
| Authorized Official Name and Position | Dan Nieberding (POLICY & COMMUNICATIONS SPECIALIST) |
| Authorized Official Contact | 7175246187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Renewal Services, Inc. Po Box 865 Westminster MD 21158-0865 Ph: () - | Life Renewal Services, Inc. 247-249 East Main Street Westminster MD 21157-5228 Ph: (410) 289-8149 |
| NPI Number | 1578995213 |
|---|---|
| Provider Enumeration Date | 08/05/2013 |
| Last Update Date | 07/09/2024 |
| Certification Date | 07/01/2024 |
| Medicare PECOS PAC ID | 8022344712 |
|---|---|
| Medicare Enrollment ID | O20190802000757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578995213 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Myun Ki Kim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104888940 PECOS PAC ID: 7719947274 Enrollment ID: I20041020000154 |
| Provider Name | Irine S Onyah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811497498 PECOS PAC ID: 2264796010 Enrollment ID: I20180503001937 |
| Provider Name | Akherenwei Gwan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447670732 PECOS PAC ID: 6204150394 Enrollment ID: I20190115001673 |
| Provider Name | Kathryn Castle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760953814 PECOS PAC ID: 0446675219 Enrollment ID: I20200811000685 |
| Provider Name | Tammy M Green |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124597638 PECOS PAC ID: 4587100466 Enrollment ID: I20240726004009 |
| Provider Name | Brittany Speert |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538880521 PECOS PAC ID: 5395284749 Enrollment ID: I20240829000323 |
| Provider Name | Katherine Leung |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629625314 PECOS PAC ID: 5991245094 Enrollment ID: I20240904000829 |
| Provider Name | Carol Poole |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295206621 PECOS PAC ID: 0941740427 Enrollment ID: I20240911000970 |
| Provider Name | Rosalind D Floyd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083107809 PECOS PAC ID: 1456600378 Enrollment ID: I20240913002403 |
| Provider Name | Patricia Estes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801306139 PECOS PAC ID: 7719428457 Enrollment ID: I20240920001391 |
| Provider Name | Allison Grillo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427605757 PECOS PAC ID: 7113468851 Enrollment ID: I20240920001588 |
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