Provider Demographics
NPI:1417195801
Name:RENFREW CENTER
Entity Type:Organization
Organization Name:RENFREW CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:2126-858-6856
Mailing Address - Street 1:11 E 36TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3318
Mailing Address - Country:US
Mailing Address - Phone:212-685-6856
Mailing Address - Fax:212-686-1865
Practice Address - Street 1:11 E 36TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3318
Practice Address - Country:US
Practice Address - Phone:212-685-6856
Practice Address - Fax:212-686-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032876302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service