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General NPI Number Information
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NPI Number | 1437624814
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Entity Type | Organization
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Legal Business Name | RENEST RECOVERY SUPPORT SERVICES
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 400 RING RD STE 155
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-8790
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Country | US
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Telephone | 844-473-6378
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Fax | 270-246-9950
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Provider Business Mailing Address
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Address Line | 400 RING RD STE 155
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-8790
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Country | US
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Telephone | 844-473-6378
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Fax | 270-360-1188
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | THERESA ANN WADDELL
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Credential | MA, CADC
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Telephone | 844-473-6378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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Taxonomy #7
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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Taxonomy #9
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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Taxonomy #10
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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