Renu Life Extended

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

HAL-096-022 Issued in NC

Legal business name

RENU LIFE EXTENDED

Practice address

501 Forest Hill Dr
Goldsboro, NC 27534-1824

Phone

(919) 734-0266

NPI assigned

Jul 16, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Diane Harrison

Title

Ceo

Phone

(919) 734-0266

Specialties & licenses 1

Addresses

Other identifiers 1

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, Inc

  • Community/Behavioral Health Agency
  • Goldsboro, NC
  • NPI 1073712428
  NPD tax ID
• Renu Life Extended, Inc

  • Community/Behavioral Health Agency
  • Goldsboro, NC
  • NPI 1346394012
  NPD tax ID

Locations

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912106378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 FOREST HILL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275341824",
            "telephone_number": "919-734-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 FOREST HILL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275341824",
            "telephone_number": "919-734-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENU LIFE EXTENDED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-734-0266"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "HAL-096-022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": "COMMUNITY SUPPORTS",
            "identifier": "8300919B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rehabfocus, LLC
• Rejuvenating Families LLC
• David Lawrence Remington, M.D.
• Renal Treatment Centers Mid Atlantic Inc (Rosewood Dialysis)
• Gina Jernigan Renfroe, SLP-MS,CCC-SLP
• Renu Life Extended, Inc
• Renu Life Extended, Inc
• Renu Life LLC
• Renu Life LLC
• Renu Life, LLC

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• 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.