Provider Demographics
NPI:1780779793
Name:RENAISSANCE COUNSELING SERVICE INC.
Entity type:Organization
Organization Name:RENAISSANCE COUNSELING SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABU
Authorized Official - Middle Name:NASIR
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-243-0530
Mailing Address - Street 1:P.O. BOX 598
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA STATION
Mailing Address - State:OH
Mailing Address - Zip Code:44028-0598
Mailing Address - Country:US
Mailing Address - Phone:440-243-0530
Mailing Address - Fax:440-237-3626
Practice Address - Street 1:5563 WOODMILL CIRCLE (HOME/BUSINESS OFFICE FOR ADMINIST
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1775
Practice Address - Country:US
Practice Address - Phone:440-243-0530
Practice Address - Fax:440-237-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114521Medicaid
OHRE9258911Medicare ID - Type UnspecifiedGROUP
OHRE9258911Medicare PIN