Provider Demographics
NPI:1699197053
Name:RENAISSANCE ADDICTION SERVICES, INC.
Entity Type:Organization
Organization Name:RENAISSANCE ADDICTION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLOUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-827-9462
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-0643
Mailing Address - Country:US
Mailing Address - Phone:716-827-6432
Mailing Address - Fax:716-827-9565
Practice Address - Street 1:920 HARLEM RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1008
Practice Address - Country:US
Practice Address - Phone:716-827-9462
Practice Address - Fax:716-827-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYE1403118303245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children