Provider Demographics
NPI:1699174839
Name:RENEWING LIFE CENTER
Entity type:Organization
Organization Name:RENEWING LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHELCHECL
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:702-434-7290
Mailing Address - Street 1:3243 E WARM SPRINGS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3185
Mailing Address - Country:US
Mailing Address - Phone:702-434-7290
Mailing Address - Fax:702-434-6940
Practice Address - Street 1:3243 E WARM SPRINGS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3185
Practice Address - Country:US
Practice Address - Phone:702-434-7290
Practice Address - Fax:702-434-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty