Organization
RENU LIFE EXTENDED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE HARRISON (CEO)
(919) 734-0266
Entity
Organization
Contact information
Practice address
501 FOREST HILL DR, GOLDSBORO, NC 27534-1824
(919) 734-0266
Mailing address
501 FOREST HILL DR, GOLDSBORO, NC 27534-1824
(919) 734-0266
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
HAL-096-022
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300919B
COMMUNITY SUPPORTS
NC
Enumeration date
07/16/2007
Last updated
08/22/2020
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