Provider Demographics
NPI:1457471385
Name:LIFE RENEWAL SERVICES, INC.
Entity Type:Organization
Organization Name:LIFE RENEWAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KANE
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-840-4116
Mailing Address - Street 1:6940 TUDSBURY RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2674
Mailing Address - Country:US
Mailing Address - Phone:410-277-8910
Mailing Address - Fax:410-277-8911
Practice Address - Street 1:6940 TUDSBURY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2674
Practice Address - Country:US
Practice Address - Phone:410-277-8910
Practice Address - Fax:410-277-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD399002800Medicaid