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General NPI Number Information
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NPI Number | 1386131092
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Entity Type | Organization
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Legal Business Name | RENASCENCE BEHAVIORAL HEALTHCARE GROUP, INC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 8553 ARGYLE BUSINESS LOOP STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6604
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Country | US
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Telephone | 904-630-5169
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Fax | 904-645-8464
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Provider Business Mailing Address
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Address Line | 8553 ARGYLE BUSINESS LOOP STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6604
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Country | US
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Telephone | 904-630-5169
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Fax | 904-645-8464
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY SUTHERLAND
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Credential | MS
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Telephone | 904-630-5169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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