Provider Demographics
NPI:1124336193
Name:PROJECT RENEW
Entity type:Organization
Organization Name:PROJECT RENEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-631-5881
Mailing Address - Street 1:315 AVENIDA SANTA BARBARA
Mailing Address - Street 2:UNIT D
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5357
Mailing Address - Country:US
Mailing Address - Phone:562-631-5881
Mailing Address - Fax:
Practice Address - Street 1:315 AVENIDA SANTA BARBARA
Practice Address - Street 2:UNIT D
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5357
Practice Address - Country:US
Practice Address - Phone:562-631-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE SERVICE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management