Organization
RENACER LATINO INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUZ R GVERO MISA II, CADC (EXECTIVE DIRECTOR)
(847) 336-7302
Entity
Organization
Contact information
Practice address
620 WASHINGTON ST, WAUKEGAN, IL 60085-5421
(847) 336-7302
Mailing address
620 WASHINGTON ST, WAUKEGAN, IL 60085-5421
(847) 336-7302
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
897
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04932522
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/18/2008
Last updated
01/18/2008
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