Provider Demographics
NPI:1457802225
Name:RENAISSANCE HEALTH SERVICES
Entity Type:Organization
Organization Name:RENAISSANCE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-842-5050
Mailing Address - Street 1:4710 PARK MNR S
Mailing Address - Street 2:APT. 5306
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4912
Mailing Address - Country:US
Mailing Address - Phone:248-842-5050
Mailing Address - Fax:866-539-2634
Practice Address - Street 1:2157 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320-1749
Practice Address - Country:US
Practice Address - Phone:248-981-7138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty