# RENAISSANCE MEDICAL GROUP,INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RenaissanceTreatment Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689713638
- **Authorized official:** ANDREA L SYPHAX (ADMINISTRATOR)
- **Authorized official phone:** (301) 925-2255

## Contact information

- **Practice address:** 525 EASTERN AVE STE B3, FAIRMOUNT HEIGHTS, MD 20743-1677
- **Practice address phone:** (301) 925-2255
- **Mailing address:** PO BOX 2966, HYATTSVILLE, MD 20784-0966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | MD | Yes |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 08/22/2020