Organization
RENEW OUT-PATIENT & RESIDENTIAL TREATMENT SERVICES LLC
Active
Parent organization
ALCOHOL & DRUG ABUSE PREVENTION & TREATMENT SPECIALTIES
Other names
RENEW Behavioral Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
ALCOHOL & DRUG ABUSE PREVENTION & TREATMENT SPECIALTIES
Authorized official
MR. EUGENE SISCO III (MANAGING MEMBER)
(606) 653-1505
Entity
Organization
Contact information
Practice address
4963 US HIGHWAY 23 S, SUITE 121, IVEL, KY 41642-9067
(606) 653-1505
Mailing address
PO BOX 678, BETSY LAYNE, KY 41605-0678
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
800139
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800139
BEHAVIORAL HEALTH SERVICES ORGANIZATION
KY
01
—
810407
ALCOHOL AN OTHER DRUG TREATMENT ENTITY
KY
Enumeration date
01/29/2015
Last updated
01/29/2015
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