Provider Demographics
NPI:1841650900
Name:RENAISSANCE HEALTH, LLC
Entity type:Organization
Organization Name:RENAISSANCE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:BRUNNER
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,RXN,PMHNP-BC
Authorized Official - Phone:720-450-7684
Mailing Address - Street 1:11310 HURON ST
Mailing Address - Street 2:#230
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3046
Mailing Address - Country:US
Mailing Address - Phone:720-450-7684
Mailing Address - Fax:
Practice Address - Street 1:11310 HURON ST
Practice Address - Street 2:#230
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3046
Practice Address - Country:US
Practice Address - Phone:720-450-7684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991291251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO952719650Medicaid