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General NPI Number Information
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NPI Number | 1467848168
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Entity Type | Organization
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Legal Business Name | RENAISSANCE RECOVERY GROUP LLC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 7220 WELLINGTON DR
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City | KNOXVILLE
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State | TN
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Zip | 37919-5955
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Country | US
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Telephone | 865-474-1299
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Fax | 865-474-9485
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Provider Business Mailing Address
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Address Line | 7220 WELLINGTON DR
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City | KNOXVILLE
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State | TN
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Zip | 37919-5955
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Country | US
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Telephone | 865-474-1299
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Fax | 865-474-9485
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | JEFF SKINNER
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Credential |
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Telephone | 865-474-1299
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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 | I000000016301
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License Number State | TN
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