Provider Demographics
NPI:1770031387
Name:RENAISSANCE RECOVERY GROUP
Entity Type:Organization
Organization Name:RENAISSANCE RECOVERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFINEY
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-474-1299
Mailing Address - Street 1:7220 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5955
Mailing Address - Country:US
Mailing Address - Phone:865-474-1299
Mailing Address - Fax:
Practice Address - Street 1:7220 WELLINGTON DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5955
Practice Address - Country:US
Practice Address - Phone:865-474-1299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty