Provider Demographics
NPI:1396308714
Name:RENEWED MENTAL HEALTH SENIOR SERVICES, LLC
Entity type:Organization
Organization Name:RENEWED MENTAL HEALTH SENIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAROMI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-858-3598
Mailing Address - Street 1:5950 LIVE OAK PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1743
Mailing Address - Country:US
Mailing Address - Phone:951-858-3598
Mailing Address - Fax:770-461-0507
Practice Address - Street 1:5950 LIVE OAK PKWY STE 240
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1743
Practice Address - Country:US
Practice Address - Phone:951-858-3598
Practice Address - Fax:770-461-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty