Provider Demographics
NPI:1255224226
Name:RENEW LIFE OUT-PATIENT RECOVERY CENTER LLC
Entity type:Organization
Organization Name:RENEW LIFE OUT-PATIENT RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER-MOOREHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-513-2262
Mailing Address - Street 1:110 MAYCOX AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3433
Mailing Address - Country:US
Mailing Address - Phone:757-991-1481
Mailing Address - Fax:
Practice Address - Street 1:110 MAYCOX AVE STE 6
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3433
Practice Address - Country:US
Practice Address - Phone:757-991-1481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health