Provider Demographics
NPI:1578693925
Name:RENOVA CENTER
Entity Type:Organization
Organization Name:RENOVA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAHAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-274-0493
Mailing Address - Street 1:25 METRO DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-9172
Mailing Address - Country:US
Mailing Address - Phone:717-274-0493
Mailing Address - Fax:717-274-2574
Practice Address - Street 1:25 METRO DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-9172
Practice Address - Country:US
Practice Address - Phone:717-274-0493
Practice Address - Fax:717-274-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA76404078315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities