Organization
RENAISSANCE BEHAVIORAL HEALTH LLC
Active
Other names
Renaissance Behavioral Health LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY TENITA CLARK CNP (PARTNER / CHIEF CLINICAL OFFICER)
(440) 606-2003
Entity
Organization
Contact information
Practice address
3740 EUCLID AVE STE 101, CLEVELAND, OH 44115-2229
(440) 606-2003
Mailing address
3740 EUCLID AVE STE 101, CLEVELAND, OH 44115-2229
(440) 606-2003
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0402869
—
OH
Enumeration date
05/09/2020
Last updated
08/16/2020
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