Organization
RENEST (I) RISE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA WADDELL MA, MFTA, CADC (ADMINISTRATIVE OFFICER)
(844) 473-6378
Entity
Organization
Contact information
Practice address
400 RING RD STE 155, ELIZABETHTOWN, KY 42701-8790
(844) 473-6378
(270) 246-9950
Mailing address
400 RING RD STE 155, ELIZABETHTOWN, KY 42701-8790
(844) 473-6378
(270) 246-9950
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
09/30/2025
Last updated
09/30/2025
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