Provider Demographics
NPI:1225373145
Name:THE RENFREW CENTERS, INC.
Entity Type:Organization
Organization Name:THE RENFREW CENTERS, INC.
Other - Org Name:THE RENFREW CENTER OF GEORGIA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MENAGED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-482-5353
Mailing Address - Street 1:8945 RIDGE AVENUE #R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128
Mailing Address - Country:US
Mailing Address - Phone:215-482-5353
Mailing Address - Fax:215-487-3972
Practice Address - Street 1:50 GLENLAKE PARKWAY NE
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:678-328-4100
Practice Address - Fax:770-671-8508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health