Provider Demographics
NPI:1487014650
Name:RENFREW CENTER
Entity Type:Organization
Organization Name:RENFREW CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORR OF NUTRITION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:KRUMHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD/N
Authorized Official - Phone:954-698-9222
Mailing Address - Street 1:10344 CANOE BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4604
Mailing Address - Country:US
Mailing Address - Phone:954-649-1470
Mailing Address - Fax:
Practice Address - Street 1:10344 CANOE BROOK CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4604
Practice Address - Country:US
Practice Address - Phone:954-649-1470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3350323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility