Provider Demographics
NPI:1134431364
Name:CHRISTUS LIFE RENEWAL CENTER
Entity type:Organization
Organization Name:CHRISTUS LIFE RENEWAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-200-3409
Mailing Address - Street 1:PO BOX 772836
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33077-2836
Mailing Address - Country:US
Mailing Address - Phone:954-200-3409
Mailing Address - Fax:
Practice Address - Street 1:7300 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5300
Practice Address - Country:US
Practice Address - Phone:954-200-3409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRUIT OF THE SPIRIT MINISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)