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General NPI Number Information
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NPI Number | 1487120143
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Entity Type | Organization
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Legal Business Name | REMEDIES RENEWING LIVES
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 1908 PIERCE CT
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City | BELVIDERE
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State | IL
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Zip | 61008-1742
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Country | US
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Telephone | 815-547-4502
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Fax | 815-544-0391
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Provider Business Mailing Address
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Address Line | 220 EASTON PKWY
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City | ROCKFORD
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State | IL
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Zip | 61108-2203
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Country | US
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Telephone | 815-966-1285
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Fax | 815-962-7895
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Authorized Official
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Title or Position | VP OF MARKETING/FUND DEVELOPMENT
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Name | KATHY S. BRANNING
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Credential | M.S., LCPC, CADC,
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Telephone | 815-966-1285
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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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