Healthcare Provider Details

I. General information

NPI: 1730009721
Provider Name (Legal Business Name): RENAISSANCE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 SW 10TH AVE STE 601
PORTLAND OR
97205-2707
US

IV. Provider business mailing address

511 SW 10TH AVE STE 601
PORTLAND OR
97205-2707
US

V. Phone/Fax

Practice location:
  • Phone: 817-770-6612
  • Fax:
Mailing address:
  • Phone: 817-770-6612
  • Fax:

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: PIE BIMENYIMANA
Title or Position: PMHNP
Credential:
Phone: 817-770-6612