Provider Demographics
NPI:1558596106
Name:RENEWING HOPE ADULT SERVICES LLC.
Entity Type:Organization
Organization Name:RENEWING HOPE ADULT SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:MARCELL
Authorized Official - Last Name:PETTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-512-8707
Mailing Address - Street 1:751 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3258
Mailing Address - Country:US
Mailing Address - Phone:704-512-8707
Mailing Address - Fax:
Practice Address - Street 1:751 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3258
Practice Address - Country:US
Practice Address - Phone:704-512-8707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management