NPIMap

Organization Active NPI

Renew Behavorial Health Inc

  • Mental Health Counselor
  • Long Beach, CA
National Provider Identifier
1033137724
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
A66124 Issued in CA
Legal business name
RENEW BEHAVORIAL HEALTH INC
Practice address
4000 Long Beach Blvd
Ste 228
Long Beach, CA 90807-2617
Phone
(562) 637-3143
Fax
(562) 637-3244
NPI assigned
Jul 18, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laja I Ibraheem, MDNPI 1811983232
Title
MD Owner
Phone
(562) 637-3143

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X A66124 CA Primary

Addresses

Primary practice location

4000 Long Beach Blvd
Ste 228
Long Beach, CA 90807-2617

Mailing address

PO Box 20140
Long Beach, CA 90801-3140
Phone (562) 637-3143

Other identifiers 1

IdentifierTypeStateIssuer
00A661240MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061017000464 CA Part B Supplier - Clinic/Group Practice 9032115936 Receives reassigned benefits from 8 practitioners
Practice locations: Long Beach, CA

National Provider Directory

National Provider Directory

Locations

4000 Long Beach Blvd
Ste 2
Long Beach, CA 90807
Phone (562) 637-3143

4000 Long Beach Blvd
Ste 228
Long Beach, CA 90807
Phone (310) 422-4426

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033137724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20140",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908013140",
            "telephone_number": "562-637-3143",
            "fax_number": "562-637-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 LONG BEACH BLVD",
            "address_2": "STE 228",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908072617",
            "telephone_number": "562-637-3143",
            "fax_number": "562-637-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW BEHAVORIAL HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IBRAHEEM",
        "authorized_official_first_name": "LAJA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "MD OWNER",
        "authorized_official_telephone_number": "562-637-3143",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "A66124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A661240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.