Provider Demographics
NPI:1396025359
Name:RENAISSANCE REMEDIAL SERVICES, INC
Entity Type:Organization
Organization Name:RENAISSANCE REMEDIAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VERSELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-594-7435
Mailing Address - Street 1:3234 FRIENDSHIP ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-5116
Mailing Address - Country:US
Mailing Address - Phone:319-594-8686
Mailing Address - Fax:319-855-4514
Practice Address - Street 1:806 5TH ST STE 210
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2361
Practice Address - Country:US
Practice Address - Phone:319-594-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000702541Medicaid