Provider Demographics
NPI:1548567738
Name:THE RENAISSANCE PROJECT INC MT VERNON
Entity Type:Organization
Organization Name:THE RENAISSANCE PROJECT INC MT VERNON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-345-1312
Mailing Address - Street 1:250 CLEARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-1305
Mailing Address - Country:US
Mailing Address - Phone:914-345-1312
Mailing Address - Fax:914-345-1318
Practice Address - Street 1:3 SOUTH 6TH. AVE.
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10551
Practice Address - Country:US
Practice Address - Phone:914-664-3730
Practice Address - Fax:914-664-1397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE RENAISSANCE PROJECT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01302538Medicaid