| Renu Life Extended, Inc | |
|
201 Windsor Creek Pkwy Goldsboro NC 27534-8696 | |
| (919) 734-0266 | |
| (919) 734-9926 |
| Full Name | Renu Life Extended, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 201 Windsor Creek Pkwy, Goldsboro, North Carolina |
| Authorized Official Name and Position | Diane Harrison (PRESIDENT) |
| Authorized Official Contact | 9197340266 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renu Life Extended, Inc Po Box 1017 Goldsboro NC 27533-1017 Ph: (919) 734-0266 | Renu Life Extended, Inc 201 Windsor Creek Pkwy Goldsboro NC 27534-8696 Ph: (919) 734-0266 |
| NPI Number | 1346394012 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 04/05/2024 |
| Certification Date | 04/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346394012 | NPI | - | NPPES |
| 7804269 | Medicaid | NC | |
| MHL-096-277 | Other | NC | DHSR |
| 3408908 | Medicaid | NC | |
| 1346394012 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 311ZA0620X | Custodial Care Facility - Adult Care Home | (* (Not Available)) | Secondary |
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