Provider Demographics
NPI:1497854137
Name:THE RENFREW CENTER, INC.
Entity Type:Organization
Organization Name:THE RENFREW CENTER, INC.
Other - Org Name:THE RENFREW CENTER OF CONNECTICUT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MENAGED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-482-5353
Mailing Address - Street 1:8945 RIDGE AVENUE #R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128
Mailing Address - Country:US
Mailing Address - Phone:215-482-5353
Mailing Address - Fax:215-487-3972
Practice Address - Street 1:1445 E. PUTNAM AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870
Practice Address - Country:US
Practice Address - Phone:203-834-5020
Practice Address - Fax:203-563-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QM0855X
CT0000-0036323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility