Provider Demographics
NPI:1528292364
Name:RENEW INTEGRATED PROGRAM #2
Entity type:Organization
Organization Name:RENEW INTEGRATED PROGRAM #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-426-3300
Mailing Address - Street 1:5200 IRWINDALE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:IRWINDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91706-2014
Mailing Address - Country:US
Mailing Address - Phone:626-960-3964
Mailing Address - Fax:
Practice Address - Street 1:5200 IRWINDALE AVE STE 210
Practice Address - Street 2:
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-2014
Practice Address - Country:US
Practice Address - Phone:626-960-3964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty