Healthcare Provider Details

I. General information

NPI: 1679691323
Provider Name (Legal Business Name): RENZ ADDICTION COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 AMERICAN WAY
ELGIN IL
60120-4341
US

IV. Provider business mailing address

2 AMERICAN WAY
ELGIN IL
60120-4341
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-3545
  • Fax: 847-697-5583
Mailing address:
  • Phone: 847-742-3545
  • Fax: 847-697-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA06090001A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA06090001A
License Number StateIL

VIII. Authorized Official

Name: MS. LORA TOVAR
Title or Position: COORD ADM SVCS
Credential:
Phone: 847-742-3545