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General NPI Number Information
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NPI Number | 1558587824
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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 | 04/17/2007
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 215 EASTON PKWY
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City | ROCKFORD
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State | IL
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Zip | 61108
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Country | US
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Telephone | 815-962-0871
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Fax | 815-962-7895
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Provider Business Mailing Address
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Address Line | 215 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 | 815-962-0871
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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 |
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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 | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | A-0559-0005-A
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License Number State | IL
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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 | A-0559-0005--A
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License Number State | IL
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