Provider Demographics
NPI:1255640165
Name:RENEWED SERVICES, INC.
Entity type:Organization
Organization Name:RENEWED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODEMBO
Authorized Official - Suffix:
Authorized Official - Credentials:QDDP/QMHP
Authorized Official - Phone:704-473-6346
Mailing Address - Street 1:110 TWIN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-0660
Mailing Address - Country:US
Mailing Address - Phone:704-473-6346
Mailing Address - Fax:704-313-3017
Practice Address - Street 1:110 TWIN LAKE DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-0660
Practice Address - Country:US
Practice Address - Phone:704-473-6346
Practice Address - Fax:704-313-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services