Provider Demographics
NPI:1255019758
Name:RENEW REENTRY HOUSE LLC
Entity type:Organization
Organization Name:RENEW REENTRY HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORVIE
Authorized Official - Middle Name:JANAY
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-432-1569
Mailing Address - Street 1:19410 NW 7TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3116
Mailing Address - Country:US
Mailing Address - Phone:305-432-1569
Mailing Address - Fax:
Practice Address - Street 1:19410 NW 7TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-3116
Practice Address - Country:US
Practice Address - Phone:305-432-1569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty