Healthcare Provider Details

I. General information

NPI: 1730205675
Provider Name (Legal Business Name): RENAISSANCE COMMUNITY HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/08/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1548 W MAUMEE STREET SUITE C
ADRIAN MI
49221
US

IV. Provider business mailing address

PO BOX 749
ADRIAN MI
49221
US

V. Phone/Fax

Practice location:
  • Phone: 734-439-0464
  • Fax: 517-438-8392
Mailing address:
  • Phone: 734-439-0464
  • Fax: 517-438-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA ANN BELL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 734-340-5707