Provider Demographics
NPI:1255561130
Name:RENEWED HOPE
Entity type:Organization
Organization Name:RENEWED HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:207-329-5864
Mailing Address - Street 1:143 HARMONS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-5621
Mailing Address - Country:US
Mailing Address - Phone:207-329-5864
Mailing Address - Fax:
Practice Address - Street 1:60 PINE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7214
Practice Address - Country:US
Practice Address - Phone:207-212-6957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-25
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4139251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health