| Renewed Mental Health Senior Services, Llc | |
|
5950 Live Oak Pkwy Ste 240 Norcross GA 30093-1743 | |
| (951) 858-3598 | |
| (770) 461-0507 |
| Full Name | Renewed Mental Health Senior Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5950 Live Oak Pkwy Ste 240, Norcross, Georgia |
| Authorized Official Name and Position | Sherian Sharomi (CEO/CLINICAL DIRECTOR) |
| Authorized Official Contact | 9518583598 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewed Mental Health Senior Services, Llc 5950 Live Oak Pkwy Ste 240 Norcross GA 30093-1743 Ph: (951) 858-3598 | Renewed Mental Health Senior Services, Llc 5950 Live Oak Pkwy Ste 240 Norcross GA 30093-1743 Ph: (951) 858-3598 |
| NPI Number | 1396308714 |
|---|---|
| Provider Enumeration Date | 04/22/2019 |
| Last Update Date | 04/21/2021 |
| Certification Date | 04/21/2021 |
| Medicare PECOS PAC ID | 6103150842 |
|---|---|
| Medicare Enrollment ID | O20190628001721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396308714 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Anthony L Hutchison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669538245 PECOS PAC ID: 6406931849 Enrollment ID: I20080311000035 |
| Provider Name | Sherian Alecia Sharomi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972838365 PECOS PAC ID: 9436438686 Enrollment ID: I20190702003664 |
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