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Organization
RENU LIFE EXTENDED, INC
Active
Organization
RENU LIFE EXTENDED, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE HARRISON (PRESIDENT)
(919) 734-0266
Entity
Organization
Contact information
Practice address
201 WINDSOR CREEK PKWY, GOLDSBORO, NC 27534-8696
(919) 734-0266
(919) 734-9926
Mailing address
PO BOX 1017, GOLDSBORO, NC 27533-1017
(919) 734-0266
(919) 734-9926
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
HAL-096-022
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300919
—
NC
01
—
MHL-096-277
DHSR
NC
Enumeration date
07/16/2007
Last updated
08/19/2021
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