Organization
RENEW RESIDENTIAL TREATMENT SERVICES
Active
Other names
Brookside
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER SISCO (OWNER)
(606) 658-3078
Entity
Organization
Contact information
Practice address
400 VENTERS LN, PIKEVILLE, KY 41501-3016
(606) 653-1874
Mailing address
PO BOX 1285, PIKEVILLE, KY 41502-1285
(606) 658-3078
(606) 773-1011
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100851810
—
KY
Enumeration date
04/11/2016
Last updated
04/18/2023
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