Basic Information
| Provider Information | |||||||||
| NPI: | 1679691323 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RENZ ADDICTION COUNSELING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601204341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477423545 | ||||||||
| FaxNumber: | 8476975583 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601204341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477423545 | ||||||||
| FaxNumber: | 8476975583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 11/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | TOVAR | ||||||||
| AuthorizedOfficialFirstName: | LORA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COORD ADM SVCS | ||||||||
| AuthorizedOfficialTelephone: | 8477423545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | A06090001A | IL | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 101YA0400X | A06090001A | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.