Provider Demographics
NPI:1578995213
Name:LIFE RENEWAL SERVICES, INC.
Entity type:Organization
Organization Name:LIFE RENEWAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:POLICY & COMMUNICATIONS SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEBERDING
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:717-524-6187
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:247-249 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5228
Practice Address - Country:US
Practice Address - Phone:410-289-8149
Practice Address - Fax:443-821-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health