Provider Demographics
NPI:1154578904
Name:RENEWED LIFE TREATMENT CENTER. INC
Entity type:Organization
Organization Name:RENEWED LIFE TREATMENT CENTER. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-793-0519
Mailing Address - Street 1:1855 E COLORADO BLVD
Mailing Address - Street 2:BLDG. B
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3554
Mailing Address - Country:US
Mailing Address - Phone:626-793-0519
Mailing Address - Fax:
Practice Address - Street 1:1855 E COLORADO BLVD
Practice Address - Street 2:BLDG. B
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3554
Practice Address - Country:US
Practice Address - Phone:626-793-0519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-23
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management