| Renew Integrated Program-2 Inc | |
|
9722 San Antonio Ave South Gate CA 90280-4620 | |
| (562) 426-3300 | |
| (562) 637-3244 |
| Full Name | Renew Integrated Program-2 Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9722 San Antonio Ave, South Gate, California |
| Authorized Official Name and Position | Laja I Ibraheem (EXECUTIVE DIRECTOR) |
| 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 Po Box 20140 Long Beach CA 90801-3140 Ph: (562) 426-3300 | Renew Integrated Program-2 Inc 9722 San Antonio Ave South Gate CA 90280-4620 Ph: (562) 426-3300 |
| NPI Number | 1366883332 |
|---|---|
| Provider Enumeration Date | 07/08/2013 |
| Last Update Date | 07/08/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366883332 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | A66124 (California) | Primary |
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