Provider Demographics
NPI:1679691323
Name:RENZ ADDICTION COUNSELING CENTER
Entity Type:Organization
Organization Name:RENZ ADDICTION COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORD ADM SVCS
Authorized Official - Prefix:MS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-742-3545
Mailing Address - Street 1:2 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4341
Mailing Address - Country:US
Mailing Address - Phone:847-742-3545
Mailing Address - Fax:847-697-5583
Practice Address - Street 1:2 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4341
Practice Address - Country:US
Practice Address - Phone:847-742-3545
Practice Address - Fax:847-697-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA06090001A101YA0400X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid