Provider Demographics
NPI:1053365015
Name:RENEWED HOPE BEHAVIORAL HEALTH PC
Entity type:Organization
Organization Name:RENEWED HOPE BEHAVIORAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZULOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-458-0811
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-0348
Mailing Address - Country:US
Mailing Address - Phone:724-458-0811
Mailing Address - Fax:
Practice Address - Street 1:15 WOODLAND CENTER DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4677
Practice Address - Country:US
Practice Address - Phone:724-458-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW013618L104100000X
PACW0126171041C0700X
PAOS008623L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014943530011Medicaid
PACH2106Medicare PIN
PA049460Medicare ID - Type Unspecified