MEDICARE: RENAISSANCE HEALTHCARE GROUP RALEIGH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1598316770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE HEALTHCARE GROUP RALEIGH, LLC

Provider Business Mailing Address
First Line	:	720 COOL SPRINGS BLVD STE 550
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2645
Country	:	US
Telephone Number	:	704-727-6997
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 CARMEL EXECUTIVE PARK DR STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1307
Country	:	US
Telephone Number	:	704-727-6997
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BENJAMIN BRADY
Credential	:
Telephone Number	:	615-260-2641

Provider Enumeration Date	:	09/27/2019
Last Update Date	:	06/10/2026

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