Healthcare Provider Details

I. General information

NPI: 1487120143
Provider Name (Legal Business Name): REMEDIES RENEWING LIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 PIERCE CT
BELVIDERE IL
61008-1742
US

IV. Provider business mailing address

220 EASTON PKWY
ROCKFORD IL
61108-2203
US

V. Phone/Fax

Practice location:
  • Phone: 815-547-4502
  • Fax: 815-544-0391
Mailing address:
  • Phone: 815-966-1285
  • Fax: 815-962-7895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHY S. BRANNING
Title or Position: VP OF MARKETING/FUND DEVELOPMENT
Credential: M.S., LCPC, CADC,
Phone: 815-966-1285