NPIMap

Organization Active NPI

Renaissance Supportive Services Inc.

  • Community/Behavioral Health Agency
  • Jacksonville, FL
National Provider Identifier
1457596678
Registry record updated Dec 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
690575796 Issued in FL
Legal business name
RENAISSANCE SUPPORTIVE SERVICES INC.
Practice address
10213 Rising Mist LN
Jacksonville, FL 32221-3006
Phone
(904) 786-6486
NPI assigned
Dec 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Latrese Curry Harrison
Title
Owner
Phone
(904) 786-6486

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 690575796 FL Primary

Addresses

Primary practice location

10213 Rising Mist LN
Jacksonville, FL 32221-3006

Mailing address

10213 Rising Mist LN
Jacksonville, FL 32221-3006
Phone (904) 786-6486

Other identifiers 1

IdentifierTypeStateIssuer
690575796MedicaidFL

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228262400000",
    "number": "1457596678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10213 RISING MIST LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322213006",
            "telephone_number": "904-786-6486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10213 RISING MIST LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322213006",
            "telephone_number": "904-786-6486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE SUPPORTIVE SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-03",
        "last_updated": "2008-12-03",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "LATRESE",
        "authorized_official_middle_name": "CURRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-786-6486",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "690575796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "690575796",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.