NPIMap

Organization Active NPI

Renaissance Challenge Conquerors Training Center

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Newark, NJ
National Provider Identifier
1437365368
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
License
2000034 Issued in NJ
Legal business name
RENAISSANCE CHALLENGE CONQUERORS TRAINING CENTER
Practice address
400 7TH Ave W
Newark, NJ 07107-1697
Phone
(973) 481-3431
NPI assigned
May 15, 2007
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
Thomas Reddick
Title
Executive Director
Phone
(973) 481-3431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X 2000034 NJ Primary

Addresses

Primary practice location

400 7TH Ave W
Newark, NJ 07107-1697

Mailing address

400 7TH Ave W
Newark, NJ 07107-1697

Other identifiers 1

IdentifierTypeStateIssuer
0060356MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Renaissance Challenge Conquerer Training Center 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.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437365368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 7TH AVE W",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071071697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 7TH AVE W",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071071697",
            "telephone_number": "973-481-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE CHALLENGE CONQUERORS TRAINING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REDDICK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "973-481-3431"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NJ",
            "license": "2000034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0060356",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.