Organization
RENEW RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS CARREON (CEO)
(330) 575-2055
Entity
Organization
Contact information
Practice address
2508 DEMINGTON AVE NW, CANTON, OH 44708-2446
(330) 575-2055
Mailing address
8109 DIAMOND PARK AVE NE, CANTON, OH 44721-7506
(330) 575-2055
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0472182
—
OH
Enumeration date
05/25/2022
Last updated
05/26/2022
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