Provider Demographics
NPI:1265910632
Name:RENAISSANCE RELATIONS, INC
Entity type:Organization
Organization Name:RENAISSANCE RELATIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:SARUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-822-0946
Mailing Address - Street 1:540 MCKENZIE AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6720
Mailing Address - Country:US
Mailing Address - Phone:404-822-0946
Mailing Address - Fax:
Practice Address - Street 1:540 MCKENZIE AVE
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6720
Practice Address - Country:US
Practice Address - Phone:404-822-0946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103K00000X, 106S00000X, 175T00000X, 251S00000X
GA309730029347C00000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003210772AMedicaid