Active NPI
Renu Life Extended, Inc
- Community/Behavioral Health Agency
- Goldsboro, NC
National Provider Identifier
1073712428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- RENU LIFE EXTENDED, INC
- Practice address
- 201 Windsor Creek Pkwy
Goldsboro, NC 27534-8696 - Phone
- (919) 734-0266
- Fax
- (919) 734-9926
- NPI assigned
- Jul 16, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Diane Harrison
- Title
- President
- Phone
- (919) 734-0266
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary | ||
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | HAL-096-022 | NC |
Addresses
Primary practice location
201 Windsor Creek Pkwy
Goldsboro, NC 27534-8696
Mailing address
PO Box 1017
Goldsboro, NC 27533-1017
Phone (919) 734-0266
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8300919 | Medicaid | NC | |
| MHL-096-277 | Other | NC | DHSR |
National Provider Directory
National Provider Directory- Tax ID family
- Renu Life Extended Inc
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Goldsboro, NC
- NPI 1912106378
-
- Community/Behavioral Health Agency
- Goldsboro, NC
- NPI 1346394012
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184544000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1629331200000",
"number": "1073712428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1017",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275331017",
"telephone_number": "919-734-0266",
"fax_number": "919-734-9926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 WINDSOR CREEK PKWY",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275348696",
"telephone_number": "919-734-0266",
"fax_number": "919-734-9926"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RENU LIFE EXTENDED, INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-07-16",
"last_updated": "2021-08-19",
"certification_date": "2021-08-19",
"status": "A",
"authorized_official_last_name": "HARRISON",
"authorized_official_first_name": "DIANE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "919-734-0266",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "320600000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "NC",
"license": "HAL-096-022",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300919",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DHSR",
"identifier": "MHL-096-277",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Goldsboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.