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General NPI Number Information
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NPI Number | 1649600834
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Entity Type | Organization
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Legal Business Name | RENAISSANCE SOUTH LA
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Dates
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Enumeration Date | 11/25/2013
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 19401 S VERMONT AVE SUITE C-100
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City | TORRANCE
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State | CA
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Zip | 90502-1029
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Country | US
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Telephone | 855-700-7752
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Fax |
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Provider Business Mailing Address
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Address Line | 19401 S VERMONT AVE SUITE C-100
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City | TORRANCE
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State | CA
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Zip | 90502-1029
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. HENRY R. ARMSTRONG III
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Credential | MBA
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Telephone | 323-872-6352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190796AN
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License Number State | CA
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