Provider Demographics
NPI:1922458108
Name:RENEW FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:RENEW FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDOUTSOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-239-8607
Mailing Address - Street 1:8080 OLD YORK RD STE 224
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1426
Mailing Address - Country:US
Mailing Address - Phone:267-626-2018
Mailing Address - Fax:267-636-5205
Practice Address - Street 1:8080 OLD YORK RD STE 224
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1426
Practice Address - Country:US
Practice Address - Phone:267-626-2018
Practice Address - Fax:267-636-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty