Organization
RENEST OF ILLINOIS SUPR
Active
Organization
RENEST OF ILLINOIS SUPR
Active
Other names
reNEST
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA WADDELL CADC, MA (ADMINISTRATIVE OFFICE)
(844) 473-6378
Entity
Organization
Contact information
Practice address
910 2ND AVE, ROCKFORD, IL 61104-2162
(844) 473-6378
(270) 246-9950
Mailing address
910 2ND AVE, ROCKFORD, IL 61104-2162
(270) 839-6743
(270) 246-9950
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A-00229-001-A
—
IL
Enumeration date
07/18/2022
Last updated
03/14/2025
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