Provider Demographics
NPI:1578435517
Name:RENEWED PURPOSE MENTAL HEALTH CARE, LLC
Entity type:Organization
Organization Name:RENEWED PURPOSE MENTAL HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:301-507-0003
Mailing Address - Street 1:13475 ATLANTIC BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3290
Mailing Address - Country:US
Mailing Address - Phone:301-507-0003
Mailing Address - Fax:301-517-9859
Practice Address - Street 1:13475 ATLANTIC BLVD STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3290
Practice Address - Country:US
Practice Address - Phone:301-507-0003
Practice Address - Fax:301-517-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty