Organization
RENAISSANCE CHALLENGE CONQUERORS TRAINING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS REDDICK (EXECUTIVE DIRECTOR)
(973) 481-3431
Entity
Organization
Contact information
Practice address
400 7TH AVE W, NEWARK, NJ 07107-1697
(973) 481-3431
Mailing address
400 7TH AVE W, NEWARK, NJ 07107-1697
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
2000034
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0060356
—
NJ
Enumeration date
05/15/2007
Last updated
08/22/2020
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