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General NPI Number Information
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NPI Number | 1891933073
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Entity Type | Organization
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Legal Business Name | RENAISSANCE CASE MANAGEMENT SERVICE
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 3103 SOUTHERN HILLS DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-3463
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Country | US
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Telephone | 281-382-4016
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Fax |
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Provider Business Mailing Address
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Address Line | 3103 SOTHERN HILLS DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459
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Country | US
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Telephone | 281-382-4016
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | MR. MICHAEL GRAVES
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Credential | RN
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Telephone | 713-528-2097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 171M00000X
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License Number State | TX
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