NPIMap

Organization Active NPI

Project Renewal Inc

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1821740275
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PROJECT RENEWAL INC
Practice address
4380 Bronx Blvd
Bronx, NY 10466-1318
Phone
(718) 414-1777
Fax
(718) 231-7235
NPI assigned
Jan 26, 2022
Last updated
Feb 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Authorized official

Name
Steven Jones
Title
Cfo
Phone
(212) 620-0340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

4380 Bronx Blvd
Bronx, NY 10466-1318

Mailing address

200 Varick St FL 9
New York, NY 10014-4810
Phone (212) 620-0340

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210816003513 NY Part A Provider - Federally Qualified Health Center (FQHC) 6901798651 1 other NPI on this enrollment
Practice locations: Bronx, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821740275. Details of each certification follow.

Federally qualified health center certification: CCN 571815

Legal name
PROJECT RENEWAL INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 5, 2021
Last certification
Aug 5, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 4, 2008 in NY
Enrollment address
4380 Bronx Blvd
Bronx, NY 10466-1318

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Project Renewal Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Colleen Cavanaugh Individual Corporate OfficerBoard Member Feb 15, 2003
Laura J Rothschild Individual Corporate OfficerBoard Member Feb 15, 2003
Steven Jones Individual Corporate DirectorChief Financial Officer Feb 10, 2003
W-2 Managing EmployeeChief Financial Officer Feb 10, 2003
Jules M Ranz Individual Corporate OfficerBoard Member Feb 15, 2003
Pamela Bell Individual Corporate OfficerBoard Member Feb 15, 2003
Geoff Proulx Individual Corporate OfficerBoard Member Feb 15, 2003
Nan Perell Individual Corporate OfficerBoard Member Feb 15, 2003
Neil S Mitchell Individual Corporate OfficerBoard Member Feb 15, 2003
Mitchell Netburn Individual Corporate OfficerBoard Member Feb 15, 2003

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1821740275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 VARICK ST FL 9",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100144810",
            "telephone_number": "212-620-0340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4380 BRONX BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104661318",
            "telephone_number": "718-414-1777",
            "fax_number": "718-231-7235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROJECT RENEWAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "212-620-0340"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.