Healthcare Provider Details

I. General information

NPI: 1235898255
Provider Name (Legal Business Name): RENAISSANCE HEALTHCARE GROUP VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 INNSLAKE DR STE 300
GLEN ALLEN VA
23060-3327
US

IV. Provider business mailing address

4050 INNSLAKE DR STE 300
GLEN ALLEN VA
23060-3327
US

V. Phone/Fax

Practice location:
  • Phone: 804-495-0383
  • Fax:
Mailing address:
  • Phone: 804-495-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT SARNACKE
Title or Position: CFO
Credential:
Phone: 615-422-7689