Provider Demographics
NPI:1396502936
Name:RENEW RECOVERY LLC DBA HOPE'S DESTINY
Entity type:Organization
Organization Name:RENEW RECOVERY LLC DBA HOPE'S DESTINY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-623-0931
Mailing Address - Street 1:HOPE'S DESTINY 601 DRESHER ROAD STE #105
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044
Mailing Address - Country:US
Mailing Address - Phone:215-780-4673
Mailing Address - Fax:215-486-0005
Practice Address - Street 1:601 DRESHER RD STE 105
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2202
Practice Address - Country:US
Practice Address - Phone:215-780-4673
Practice Address - Fax:215-486-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health