Provider Demographics
NPI:1598950370
Name:RENAISSANCE HEALTHCARE LLC
Entity Type:Organization
Organization Name:RENAISSANCE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOUBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-387-5585
Mailing Address - Street 1:251 FLORIDA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70801-1703
Mailing Address - Country:US
Mailing Address - Phone:225-387-5585
Mailing Address - Fax:225-387-5584
Practice Address - Street 1:3321 YOUREE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2123
Practice Address - Country:US
Practice Address - Phone:318-868-6033
Practice Address - Fax:318-868-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)