Healthcare Provider Details

I. General information

NPI: 1366081960
Provider Name (Legal Business Name): RENAISSANCE DISCOVERY HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 PLEASANT HILL RD STE 110
DULUTH GA
30096-1609
US

IV. Provider business mailing address

4233 PLEASANT HILL RD STE 110
DULUTH GA
30096-1609
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-0550
  • Fax:
Mailing address:
  • Phone: 770-559-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: DARRELL HALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 770-559-0550