| Renewed Light Llc | |
|
1225 N Broad St Ste 1 West Deptford NJ 08096-1203 | |
| (856) 508-4925 | |
| (856) 861-1216 |
| Full Name | Renewed Light Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1225 N Broad St Ste 1, West Deptford, New Jersey |
| Authorized Official Name and Position | Nicholas Desimone (CEO/OWNER) |
| Authorized Official Contact | 8565084925 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewed Light Llc 1225 N Broad St Ste 1 West Deptford NJ 08096-1203 Ph: (856) 508-4925 | Renewed Light Llc 1225 N Broad St Ste 1 West Deptford NJ 08096-1203 Ph: (856) 508-4925 |
| NPI Number | 1104578889 |
|---|---|
| Provider Enumeration Date | 01/24/2022 |
| Last Update Date | 01/24/2022 |
| Certification Date | 01/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104578889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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