Provider Demographics
NPI:1881295848
Name:RENAISSANCE MENTAL HEALTH CORPORATION
Entity type:Organization
Organization Name:RENAISSANCE MENTAL HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DBH
Authorized Official - Phone:702-930-5958
Mailing Address - Street 1:3663 E SUNSET RD STE 201C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3246
Mailing Address - Country:US
Mailing Address - Phone:702-930-5958
Mailing Address - Fax:702-920-8475
Practice Address - Street 1:3663 E SUNSET RD STE 201C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3246
Practice Address - Country:US
Practice Address - Phone:702-930-5958
Practice Address - Fax:702-920-8475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)