| Renew Integrated Program-2 Inc. | |
|
14135 Fairgrove Ave La Puente CA 91746-1708 | |
| (562) 426-3300 | |
| (562) 637-3244 |
| Full Name | Renew Integrated Program-2 Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 14135 Fairgrove Ave, La Puente, California |
| Authorized Official Name and Position | Laja I. Ibraheem (OWNER) |
| Authorized Official Contact | 5624263300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Integrated Program-2 Inc. 4000 Long Beach Blvd 228 Long Beach CA 90807-2617 Ph: (562) 426-3300 | Renew Integrated Program-2 Inc. 14135 Fairgrove Ave La Puente CA 91746-1708 Ph: (562) 426-3300 |
| NPI Number | 1033479993 |
|---|---|
| Provider Enumeration Date | 05/24/2012 |
| Last Update Date | 05/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033479993 | NPI | - | NPPES |
| 7205 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | A66124 (California) | Primary |
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