Provider Demographics
NPI:1982436713
Name:RENAISSANCE MEDICAL TRAINING GROUP
Entity type:Organization
Organization Name:RENAISSANCE MEDICAL TRAINING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:757-335-4400
Mailing Address - Street 1:716 DENBIGH BLVD STE C3
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4414
Mailing Address - Country:US
Mailing Address - Phone:757-809-2240
Mailing Address - Fax:757-540-1022
Practice Address - Street 1:716 DENBIGH BLVD STE C3
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4414
Practice Address - Country:US
Practice Address - Phone:757-809-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)