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General NPI Number Information
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NPI Number | 1740907096
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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 | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 413 E DIXIE AVE STE 106
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-1162
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Country | US
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Telephone | 270-839-6743
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Fax | 270-506-3253
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Provider Business Mailing Address
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Address Line | 413 E DIXIE AVE STE 106
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-1162
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Country | US
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Telephone | 270-839-6743
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | THERESA ANN WADDELL
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Credential | MA, CADC
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Telephone | 270-839-6743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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Taxonomy #2
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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