Renest of Illinois Supr

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

RENEST OF ILLINOIS SUPR

Practice address

910 2ND Ave
Rockford, IL 61104-2162

Phone

(844) 473-6378

Fax

(270) 246-9950

NPI assigned

Jul 18, 2022

Organization subpart

No

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

Authorized official

Name

Theresa Waddell, CADC, MA

Title

Administrative Office

Phone

(844) 473-6378

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• reNEST Doing business as

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

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741910400000",
    "number": "1871228494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 2ND AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042162",
            "telephone_number": "270-839-6743",
            "fax_number": "270-246-9950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 2ND AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042162",
            "telephone_number": "844-473-6378",
            "fax_number": "270-246-9950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEST OF ILLINOIS SUPR",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-18",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "ADMINISTRATIVE OFFICE",
        "authorized_official_telephone_number": "844-473-6378",
        "authorized_official_credential": "CADC, MA"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A-00229-001-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "reNEST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Remedios-Smith, M.D.
• Renal Treatment Centers-Illinois Inc
• Renal Treatment Centers-Illinois Inc.
• Megan Renaud, AGPCNP
• Renee a McArdle Psy D & Rev Frank S Moyer P C
• Renest Recovery Support Services of Illinois
• Kendra Renfro, APRN, WHNP
• Renita Shores-Gaston
• William S Renk, MD
• Catherine Lucas Rennert, LCPC

• Substance Use Disorder Rehabilitation Clinic/Center in Rockford, IL
• Providers in Rockford, IL by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; 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.