Provider Demographics
NPI:1720680523
Name:RENAISSANCE ACADEMY
Entity Type:Organization
Organization Name:RENAISSANCE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAMAKLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-260-4888
Mailing Address - Street 1:805 E WHITNER ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-1757
Mailing Address - Country:US
Mailing Address - Phone:864-260-4888
Mailing Address - Fax:864-260-4004
Practice Address - Street 1:805 E WHITNER ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-1757
Practice Address - Country:US
Practice Address - Phone:864-260-4888
Practice Address - Fax:864-260-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)