Provider Demographics
NPI:1972382182
Name:THE RENAISSANCE HOUSE
Entity Type:Organization
Organization Name:THE RENAISSANCE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-638-1239
Mailing Address - Street 1:400 OLD HIGHWAY RD
Mailing Address - Street 2:
Mailing Address - City:GARYSBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27831-3001
Mailing Address - Country:US
Mailing Address - Phone:191-963-8123
Mailing Address - Fax:
Practice Address - Street 1:114 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NC
Practice Address - Zip Code:27845-9419
Practice Address - Country:US
Practice Address - Phone:919-638-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable