Renu Life LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

MHL-096-078 Issued in NC

Legal business name

RENU LIFE LLC

Practice address

304 S Pineview Ave
Goldsboro, NC 27530-6037

Phone

(919) 734-0266

Fax

(919) 734-9926

NPI assigned

Jul 16, 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 2

Tax ID family

Lakeview7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

• Lakeview

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Goldsboro, NC
  • NPI 1366677361
  NPD tax ID
• Pineview

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Goldsboro, NC
  • NPI 1518192517
  NPD tax ID
• Renu Life LLC

  • Adult Care Home Facility
  • Goldsboro, NC
  • NPI 1255485959
  NPD tax ID
• Renu Life, LLC

  • Community/Behavioral Health Agency
  • Goldsboro, NC
  • NPI 1831330356
  NPD tax ID
• Taylor Home

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Goldsboro, NC
  • NPI 1558596536
  NPD tax ID
• Tinderwood

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Goldsboro, NC
  • NPI 1477788446
  NPD tax ID

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445904000000",
    "number": "1407055858",
    "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": "304 S PINEVIEW AVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275306037",
            "telephone_number": "919-734-0266",
            "fax_number": "919-734-9926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENU LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2015-10-27",
        "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": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-096-078",
            "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": "7804269",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803379",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina Jernigan Renfroe, SLP-MS,CCC-SLP
• Renu Life Extended
• Renu Life Extended, Inc
• Renu Life Extended, Inc
• Renu Life LLC
• Renu Life, LLC
• Jonathan Edward Reppel, D.O.
• Resilience & Restore Counseling Services, PLLC
• Resolved Solutions Agency LLC
• Victoria McIntosh Respess, ANP

• Adult Care Home Facility in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; 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.