Healthcare Provider Details

I. General information

NPI: 1477079028
Provider Name (Legal Business Name): RENAISSANCE HEALTHCARE GROUP RALEIGH,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 HIGH HOUSE RD STE 200
CARY NC
27513-8496
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD STE 550
FRANKLIN TN
37067-2645
US

V. Phone/Fax

Practice location:
  • Phone: 919-578-8250
  • Fax:
Mailing address:
  • Phone: 919-578-8250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN BRADY
Title or Position: CFO
Credential:
Phone: 615-260-2641