RENEW WELLNESS CENTER (NPI# 1548746456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548746456 |
| Entity Type | Organization |
| Organization Name | RENEW WELLNESS CENTER |
| Practice Address |
2 5th St N Ste 202 Great Falls MT 59401-4011 |
| Mailing Address |
Po Box 2691 Great Falls MT 59403-2691 |
| Practice Telephone | 4064539355 |
| Practice Fax Number | 8442741180 |
| Mailing Telephone | 4064539355 |
| Mailing Fax Number | 8442741180 |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2018-07-13 |
| Authorized Official Name | STACY PETERSON (CO-OWNER) |
| Authorized Official Telephone | 4068686163 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | KOVPYU3GG | 05 | |
| MT | 7178366 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | RENEW WELLNESS CENTER PLLC | 2 5th St N Ste 202, Great Falls, MT 59401-4011 |
| Street Address |
2 5TH ST N STE 202 |
| City | GREAT FALLS |
| State | MT |
| Zip Code | 59401-4011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992259519 | Stacy Peterson | Counselor | 2 5th St N Ste 202, Great Falls, MT 59401-4011 | 2016-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578025375 | Stacy A Mckittrick | Counselor | 26 4th St S, Great Falls, MT 59401 | 2019-04-02 |
| 1710429956 | Kenneth Engelhardt | Counselor | 2501 2nd Avenue North, Great Falls, MT 59401 | 2016-11-04 |
| 1043675945 | Nathan Wade Steward | Counselor | 926 8th Ave North, Great Falls, MT 59401 | 2015-12-18 |
| 1720464340 | Rivers Edge Dental | Health Maintenance Organization | 1900 River Drive North, Great Falls, MT 59401 | 2015-08-05 |
| 1508261140 | Maryann Dubay | Counselor | 26 4th Street North, Gateway Community Services, Great Falls, MT 59401 | 2014-10-24 |
| 1508291303 | Teresa Schmit | Social Worker | 410 Central Ave Ste 507, Great Falls, MT 59401 | 2013-09-11 |
| 1851651863 | Teresa Marie Mouser | Counselor | 1601 2nd Ave N Ste 208, Great Falls, MT 59401 | 2012-05-23 |
| 1952683542 | Mary Dolores Mancillas-loveless | Physical Therapy Assistant | 612 1st Ave. So., Great Falls, MT 59401 | 2011-09-09 |
| 1629363338 | Tanya Lee Harant | Technician, Other | 614 Central Ave., Great Falls, MT 59401 | 2011-06-10 |
| 1528384500 | Bridget Troy Hanson | Social Worker | 1601 2nd Ave N Ste 450, Great Falls, MT 59401 | 2010-04-15 |
| Find all providers in zip 59401 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487885539 | Falls Neuropsychological Services, P.C. | Clinic/Center | 1601 2nd Ave N Ste 650, Great Falls, MT 59401-3223 | 2009-08-06 |
| 1144251885 | Center for Mental Health | Clinic/Center | 915 1st Ave S, Great Falls, MT 59401-3705 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073111746 | Integrative Mental Health Services, Pllc | Clinic/Center | 926 Main St Ste 14, Billings, MT 59105-3359 | 2020-10-14 |
| 1104434422 | Grace Counseling, Pllc | Clinic/Center | 1629 Avenue D Ste A4, Billings, MT 59102-3042 | 2020-07-22 |
| 1164045373 | Align Life Mental Health Mental Health Services LLC | Clinic/Center | 305 W Mercury St Ste 407, Butte, MT 59701-1672 | 2020-05-21 |
| 1588216535 | Diversified Therapeutic Services, Pllc | Clinic/Center | 30 E Washinton St, Suite A, Kalispell, MT 59901 | 2019-07-10 |
| 1336701473 | Realization Therapy, Pllc | Clinic/Center | 115 W 3rd St Ste 205, Stevensville, MT 59870-2034 | 2019-06-28 |
| 1154802676 | Peak Mental Health, LLC | Clinic/Center | 120 S. Main St, Suite 102, Sheridan, MT 59749 | 2018-08-23 |
| 1083947055 | Sunburst Community Service Foundation, Inc | Clinic/Center | 109 1st Avenue, St Ignatius, MT 59865 | 2009-09-09 |
| 1629104229 | Lds Family Services | Clinic/Center | 2620 Colonial Dr Ste D, Helena, MT 59601-8042 | 2007-02-26 |
| 1710994843 | New Life Counseling P.C. | Clinic/Center | 121 W Magnolia Dr, Belgrade, MT 59714-9584 | 2006-08-02 |
| 1609485747 | Courtney Richards, Lcpc, Pllc | Clinic/Center | 1048 Burlington Ave Ste 108, Missoula, MT 59801-5684 | 2020-07-24 |
| Find all providers with the same taxonomy | ||||
| City | GREAT FALLS |
| Zip Code | 59401 |
Please comment or provide details below to improve the information on RENEW WELLNESS CENTER.
| 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.