Provider Demographics
NPI:1689138919
Name:RENEWAL SOLUTIONS PLLC
Entity Type:Organization
Organization Name:RENEWAL SOLUTIONS PLLC
Other - Org Name:INTEGRATED ADDICTION SOLUTIONS PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:III
Authorized Official - Credentials:MBA
Authorized Official - Phone:910-687-6187
Mailing Address - Street 1:695 S BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5919
Mailing Address - Country:US
Mailing Address - Phone:910-687-6187
Mailing Address - Fax:
Practice Address - Street 1:695 S BENNETT ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5919
Practice Address - Country:US
Practice Address - Phone:910-687-6187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC224226OtherNCMB