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General NPI Number Information
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NPI Number | 1891216511
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Entity Type | Organization
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Legal Business Name | RENAISSANCE RECOVERY, LLC
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 10175 SLATER AVENUE SUITE 111
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-9270
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Country | US
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Telephone | 203-450-8824
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Fax |
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Provider Business Mailing Address
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Address Line | 10175 SLATER AVE STE 200
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4702
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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 | HUMAN RESOURCES
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Name | JAMIE COURTNEY
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Credential |
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Telephone | 949-467-4801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 |
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License Number State |
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Taxonomy #3
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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 |
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License Number State |
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