Healthcare Provider Details

I. General information

NPI: 1992089544
Provider Name (Legal Business Name): RENAISSANCE BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 BACH WAY
NORTH LASVEGAS NV
89032
US

IV. Provider business mailing address

3829 BACH WAY
NOTH LAS VEGAS NV
89032
US

V. Phone/Fax

Practice location:
  • Phone: 702-349-7331
  • Fax: 702-982-8398
Mailing address:
  • Phone: 702-349-7331
  • Fax: 702-982-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMI VERNETTE BASS
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 702-349-7331