Organization
RENU LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE HARRISON (PRESIDENT)
(919) 734-0266
Entity
Organization
Contact information
Practice address
102 TINDERWOOD DR, GOLDSBORO, NC 27534-7856
(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
311ZA0620X
Adult Care Home Facility
Primary
MHL-096-088
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-096-078
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7803464
—
NC
05
—
7803548
—
NC
05
—
7803926
—
NC
05
—
8300920
—
NC
Enumeration date
01/22/2007
Last updated
11/02/2015
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