Provider Demographics
NPI:1295592483
Name:RENEW360 LLC
Entity type:Organization
Organization Name:RENEW360 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:STONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:732-244-6771
Mailing Address - Street 1:432 LAKEHURST RD STE 2
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-7333
Mailing Address - Country:US
Mailing Address - Phone:732-244-6771
Mailing Address - Fax:
Practice Address - Street 1:1181 ROUTE 37 WEST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-244-6771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility