Provider Demographics
NPI:1003090473
Name:RENAISSANCE CASE MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:RENAISSANCE CASE MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CPT, MT,
Authorized Official - Phone:713-528-2097
Mailing Address - Street 1:4141 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 510
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7313
Mailing Address - Country:US
Mailing Address - Phone:713-528-2097
Mailing Address - Fax:713-665-7702
Practice Address - Street 1:4141 SOUTHWEST FWY
Practice Address - Street 2:SUITE 510
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7313
Practice Address - Country:US
Practice Address - Phone:713-528-2097
Practice Address - Fax:713-665-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-55949171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043494404Medicaid
TX1194857821Medicaid