Provider Demographics
NPI:1407986367
Name:NEWARK RENAISSANCE HOUSE, INC
Entity Type:Organization
Organization Name:NEWARK RENAISSANCE HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DIFLUMERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-623-3386
Mailing Address - Street 1:50 NORFOLK ST # 56
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3228
Mailing Address - Country:US
Mailing Address - Phone:973-623-3386
Mailing Address - Fax:
Practice Address - Street 1:50 NORFOLK ST # 56
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3228
Practice Address - Country:US
Practice Address - Phone:973-623-3386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0113934324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7605501Medicaid
NJ0102202Medicaid