Provider Demographics
NPI:1225580913
Name:INSIGHT RENEWAL CENTER
Entity Type:Organization
Organization Name:INSIGHT RENEWAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-414-0111
Mailing Address - Street 1:12410 CANTRELL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0038
Mailing Address - Country:US
Mailing Address - Phone:501-414-0111
Mailing Address - Fax:501-222-1309
Practice Address - Street 1:12410 CANTRELL RD STE 202
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-0038
Practice Address - Country:US
Practice Address - Phone:015-414-0111
Practice Address - Fax:501-222-1309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1307-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1225580913OtherGROUP NPI NUMBER
AR40904OtherMHN
ARBW213OtherTRUE BLUE PPO
AR5W213OtherARKANSAS BCBS PPP
AR1356431928OtherINDIVIDUAL NPI NUMBER
AR508460000-00OtherQUALCHOICE/QCA
AR5W213OtherHEALTH ADVANTAGE
AR508460000-00OtherQUALCHOICE/QCA
AR5W213OtherARKANSAS BCBS PPP