| 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 |
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