Renu Life Extended, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

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

Jan 22, 2007

Organization subpart

No

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

Addresses

Other identifiers 4

Tax ID family

Renu Life Extended Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Renu Life Extended

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Goldsboro, NC
  • NPI 1912106378
  NPD tax ID
• Renu Life Extended, Inc

  • Community/Behavioral Health Agency
  • Goldsboro, NC
  • NPI 1073712428
  NPD tax ID

Locations

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1346394012",
    "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": "2007-01-22",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "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": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804269",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHSR",
            "identifier": "MHL-096-277",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408908",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346394012",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Lawrence Remington, M.D.
• Renal Treatment Centers Mid Atlantic Inc
• Gina Jernigan Renfroe, SLP-MS,CCC-SLP
• Renu Life Extended
• Renu Life Extended, Inc
• Renu Life LLC
• Renu Life LLC
• Renu Life, LLC
• Jonathan Edward Reppel, D.O.
• Resilience & Restore Counseling Services, PLLC

• Community/Behavioral Health Agency in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.