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General NPI Number Information
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NPI Number | 1114175908
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Entity Type | Organization
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Legal Business Name | RENAISSANCE RECOVERY SERVICES, LLC
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 30101 AGOURA CT LBBY 3
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4300
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Country | US
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Telephone | 818-707-8102
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Fax | 818-707-8111
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Provider Business Mailing Address
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Address Line | 30765 PACIFIC COAST HWY # 356
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City | MALIBU
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State | CA
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Zip | 90265-3646
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Country | US
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Telephone | 818-707-8102
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Fax | 818-707-8111
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SALVATORE PETRUCCI
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Credential |
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Telephone | 818-707-8102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190392BP
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190392AP
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License Number State | CA
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