Provider Demographics
NPI:1871207001
Name:THE RENEW GROUP LLC
Entity type:Organization
Organization Name:THE RENEW GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUTTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-487-0036
Mailing Address - Street 1:4840 E JASMINE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-3321
Mailing Address - Country:US
Mailing Address - Phone:480-930-8486
Mailing Address - Fax:
Practice Address - Street 1:9138 E DENNIS ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-6008
Practice Address - Country:US
Practice Address - Phone:602-704-1556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility