FAMILY RENEWED, LLC (NPI# 1225404551) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225404551 |
| Entity Type | Organization |
| Organization Name | FAMILY RENEWED, LLC |
| Other Organization Name | DAWN M. PORTER, MD |
| Practice Address |
1004 Pebble Beach Dr Caseyville IL 62232-2834 |
| Practice Telephone | 9134610369 |
| Practice Fax Number | 9134610832 |
| Mailing Telephone | 9134610369 |
| Mailing Fax Number | 9134610832 |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2015-08-21 |
| Authorized Official Name | DR. DAWN MICHELLE PORTER (FOUNDER/CEO) |
| Authorized Official Telephone | 9134610369 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
113680 | MO | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Dawn M. Porter, MD | Doing Business As Name - Organization |
| Street Address |
1004 PEBBLE BEACH DR |
| City | CASEYVILLE |
| State | IL |
| Zip Code | 62232-2834 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659850451 | Allison R Tojo | Counselor | Gateway Foundation, Inc., 600 W. Lincoln Avenue, Caseyville, IL 62232 | 2018-08-13 |
| 1265818025 | Jessica Penny | Developmental Therapist | 435 S 4th St, Caseyville, IL 62232 | 2015-08-04 |
| 1477849909 | Gateway Foundation, Inc. | Substance Abuse Rehabilitation Facility | 600 W. Lincoln Street, East, Caseyville, IL 62232 | 2011-06-23 |
| 1902909153 | Jean Evelyn Vogel Wagner | Pediatrics | 1230 George E Chance Parkway, Caseyville, IL 62232 | 2006-09-06 |
| 1215922000 | Mark Edward Mcgranahan | Pediatrics | 1230 George E. Chance Parkway, Caseyville, IL 62232 | 2005-09-16 |
| 1053577387 | A To Z Pediatrics, LLP | Pediatrics | 1230 George E. Chance Parkway, Caseyville, IL 62232 | 2008-08-06 |
| 1699884825 | Lori Lee Eberhart | Pediatrics | 1230 George E. Chance Parkway, Caseyville, IL 62232 | 2006-08-30 |
| 1811517360 | Shawna Renae Galonda Herndon | Massage Therapist | 16 E Reynolds St, Caseyville, IL 62232-1014 | 2020-04-24 |
| 1851889331 | Melissa Hill | Pediatrics | 1230 Tanglewood Pkwy, Caseyville, IL 62232-1101 | 2018-04-30 |
| 1407491319 | Joseph Daesch | Nurse Practitioner | 1230 Tanglewood Pkwy, Caseyville, IL 62232-1101 | 2019-11-14 |
| Find all providers in zip 62232 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144851684 | Greywood Health Center LLC | Psychiatry & Neurology | 303 W Institute Pl Fl 3, Chicago, IL 60610-3080 | 2020-02-03 |
| 1285273540 | Tms Clinical Services Pllc | Psychiatry & Neurology | 1100 Jorie Blvd Ste 172, Oak Brook, IL 60523-4409 | 2020-01-03 |
| 1942702386 | Brain and Wellness Institute LLC | Psychiatry & Neurology | 30 W Oak St Apt 14a, Chicago, IL 60610-8724 | 2018-03-01 |
| 1598278749 | Elemental Treatment Center Ltd | Psychiatry & Neurology | 612 S Western Ave Apt 1, Chicago, IL 60612-4682 | 2017-11-09 |
| 1487032082 | Jerry Francisco Benzl | Psychiatry & Neurology | 1740 Taylor St., Chicago, IL 60612 | 2015-05-14 |
| 1942697800 | Dr Mo S.c | Psychiatry & Neurology | 2131 W Silverleaf Ln, Addison, IL 60101-6404 | 2015-04-17 |
| 1104234046 | Hitekshya Nepal | Psychiatry & Neurology | 5230 6th Street Frontage Rd E, Springfield, IL 62703-5128 | 2014-07-23 |
| 1740558261 | Jyoti Shah | Psychiatry & Neurology | 1335 N Mill St Ste 100, Naperville, IL 60563-2047 | 2011-12-12 |
| 1083921530 | Jodi Chase | Psychiatry & Neurology | 480 Elm Pl Ste 106, Highland Park, IL 60035-2535 | 2010-09-04 |
| 1831424712 | Nausheen Hafiz-din | Psychiatry & Neurology | 600 Fox Glen Ct, Barrington, IL 60010-1834 | 2009-10-09 |
| Find all providers with the same taxonomy | ||||
| City | CASEYVILLE |
| Zip Code | 62232 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.