Healthcare Provider Details

I. General information

NPI: 1851256424
Provider Name (Legal Business Name): RENAISSANCE HEALTHCARE GROUP VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1897 MANAKINTOWN FERRY RD
MIDLOTHIAN VA
23113-9302
US

IV. Provider business mailing address

1039 MONTICELLO DR
ANDERSON IN
46011-1223
US

V. Phone/Fax

Practice location:
  • Phone: 615-864-8145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RUSH BRADY
Title or Position: CFO
Credential:
Phone: 615-434-2911