Provider Demographics
NPI:1942779467
Name:POLARIS RENEWAL SERVICES, INC.
Entity Type:Organization
Organization Name:POLARIS RENEWAL SERVICES, INC.
Other - Org Name:MEDMARK TREATMENT CENTERS LEMONT FURNACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-379-3300
Mailing Address - Street 1:1720 LAKEPOINTE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6425
Mailing Address - Country:US
Mailing Address - Phone:214-379-3300
Mailing Address - Fax:214-853-3018
Practice Address - Street 1:2262 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LEMONT FURNACE
Practice Address - State:PA
Practice Address - Zip Code:15456-1332
Practice Address - Country:US
Practice Address - Phone:724-323-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POLARIS RENEWAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-14
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone