Provider Demographics
NPI:1811398803
Name:THE RENFREW CENTERS, INC.
Entity Type:Organization
Organization Name:THE RENFREW CENTERS, INC.
Other - Org Name:THE RENFREW CENTER OF ILLINOIS, 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 1:5 REVERE DRIVE
Practice Address - Street 2:ONE NORTHBROOK PLACE, SUITE 100
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-291-6805
Practice Address - Fax:847-291-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
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