Provider Demographics
NPI:1992089544
Name:RENAISSANCE BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:RENAISSANCE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:VERNETTE
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-349-7331
Mailing Address - Street 1:3829 BACH WAY
Mailing Address - Street 2:
Mailing Address - City:NOTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-349-7331
Mailing Address - Fax:702-982-8398
Practice Address - Street 1:3829 BACH WAY
Practice Address - Street 2:
Practice Address - City:NORTH LASVEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-349-7331
Practice Address - Fax:702-982-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health