Provider Demographics
NPI:1225496326
Name:THE RENFREW CENTER
Entity Type:Organization
Organization Name:THE RENFREW CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP CLINICAL AND ADMIN OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISHKAT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:443-841-7785
Mailing Address - Street 1:1122 KENILWORTH DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2139
Mailing Address - Country:US
Mailing Address - Phone:443-841-7785
Mailing Address - Fax:
Practice Address - Street 1:1122 KENILWORTH DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2139
Practice Address - Country:US
Practice Address - Phone:443-841-7785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3912133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty