=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962364018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORGANIZACION RENACER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2025
-----------------------------------------------------
Last Update Date | 11/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1012 N UNIVERSITY BLVD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45042-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-464-5636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1012 N UNIVERSITY BLVD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45042-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-464-5636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | JANNETT J HERNANDEZ
-----------------------------------------------------
Credential | MSW, LSW
-----------------------------------------------------
Telephone | 513-266-2902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------