RENEW ADDICTION TREATMENT CENTER (NPI# 1063810091) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063810091 |
| Entity Type | Organization |
| Organization Name | RENEW ADDICTION TREATMENT CENTER |
| Other Organization Name | RENEW ATC |
| Practice Address |
286 Us Highway 23 N Prestonsburg KY 41653-8732 |
| Mailing Address |
400 Venters Ln Pikeville KY 41501-3016 |
| Practice Telephone | 6066531874 |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | MR. EUGENE SISCO III (MANAGING MEMBER) |
| Authorized Official Telephone | 6066531505 |
| Is Organization Subpart | Y |
| Parent Organization Name | ADAPT |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
740318 | KY | Allopathic & Osteopathic Physicians |
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
740318 | KY | Allopathic & Osteopathic Physicians |
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
740318 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | STATE FACILITY LICENSE- SPECIAL HEALTH CLINIC | 740318 | 01 |
| Other Name | Type Code |
|---|---|
| Renew ATC | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4963 Us Highway 23 S, Suite 121, Ivel, KY 416429067 | 6066531505 |
| Street Address |
286 US HIGHWAY 23 N |
| City | PRESTONSBURG |
| State | KY |
| Zip Code | 41653-8732 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790763449 | Gerald E Payne | Physician Assistant | 286 Us Highway 23 N, Suite 102, Prestonsburg, KY 41653-8732 | 2006-01-04 |
| 1518582675 | Cornerstone Care Associates | Pharmacy | 286 Us Highway 23 N, Prestonsburg, KY 41653-8732 | 2020-06-14 |
| 1841697398 | Renew Labs, LLC | Clinical Medical Laboratory | 286 Us Highway 23 N, Prestonsburg, KY 41653-8732 | 2014-11-28 |
| 1336579796 | Candace Engle | Nurse Practitioner | 286 Us Highway 23 N, Prestonsburg, KY 41653-8732 | 2013-11-22 |
| 1285976621 | Rhonda Michelle Hoskins | Nurse Practitioner | 286 Us Highway 23 N, Prestonsburg, KY 41653-8732 | 2013-03-25 |
| 1275827495 | Louisa Elizabeth Farley | Nurse Practitioner | 286 Us Highway 23 N, Prestonsburg, KY 41653-8732 | 2011-06-06 |
| 1447576103 | Mark J Martin | Nurse Practitioner | 286 Us Highway 23 N, Prestonsburg, KY 41653-8732 | 2010-04-20 |
| 1407004880 | Demosthenes N Sarlis | Physical Medicine & Rehabilitation | 286 Us Highway 23 N, Prestonsburg, KY 41653-8732 | 2008-08-28 |
| 1477665321 | Kentucky Pain Physicians | Non-Pharmacy Dispensing Site | 286 Us Highway 23 N, Ste 102, Prestonsburg, KY 41653-8732 | 2006-08-31 |
| 1477589463 | Robert B Hays | Physician Assistant | 286 Us Highway 23 N, Suite 102, Prestonsburg, KY 41653-8732 | 2006-06-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568094670 | Commonwealth Community Care Centers, LLC | Obstetrics & Gynecology | 156 North Lake Drive, Prestonburg, KY 41653 | 2020-02-06 |
| 1336781152 | Toni Coleman | Counselor | 104 South Front Ave, Prestonsburg, KY 41653 | 2019-10-14 |
| 1063070043 | Beverly Jane Daniel | Nurse Practitioner | 5230-ky-321#8, Prestonsburg, KY 41653 | 2019-06-04 |
| 1760966519 | Mackenzie Alvarez | Counselor | 104 South Front Avenue, Prestonsburg, KY 41653 | 2018-09-18 |
| 1427409739 | Css Rehab Services | Early Intervention Provider Agency | 165 Ridgewood Drive, Prestonsburg, KY 41653 | 2016-06-28 |
| 1356745509 | Rosanna Mccoy | Counselor | 105 Trimble Chapel Square, Prestonsburg, KY 41653 | 2014-10-17 |
| 1770828766 | Mary Whitney Amburgey | Physical Therapist | 5000 Ky-321, Prestonsburg, KY 41653 | 2012-12-03 |
| 1750648168 | Cynthia Crase | Social Worker | 311 N Arnold Ave Ste 504, Prestonsburg, KY 41653 | 2012-04-23 |
| 1003107566 | Shane Hensley | Pharmacist | 152 Collins Circle, Prestonsburg, KY 41653 | 2011-05-02 |
| 1659607018 | Paul Michael Burchett | Pharmacist | 5291 Ky Rte 321, Prestonsburg, KY 41653 | 2009-10-20 |
| Find all providers in zip 41653 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588692503 | Jody Michael Johnson | Family Medicine | 5000 Ky Route 321, Suite 3141, Prestonsburg, KY 41653 | 2006-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104431543 | Stephanie Caudill | Family Medicine | 1145 W Lexington Ave Ste C, Winchester, KY 40391-1290 | 2020-09-12 |
| 1083231682 | Cherawen Group | Family Medicine | 4060 Troy Pike, Versailles, KY 40383-8924 | 2020-06-30 |
| 1295357531 | Unbound Treatment, Inc. | Family Medicine | 67 Harbor Dr, Jamestown, KY 42629-8036 | 2020-05-09 |
| 1891294336 | Nanncoh LLC | Family Medicine | 700 Envoy Cir Ste 702, Louisville, KY 40299-1812 | 2018-02-11 |
| 1942667456 | Crossroads Addiction Recovery Effort, LLC | Family Medicine | 484 Tollage Crk, Pikeville, KY 41501 | 2016-01-28 |
| 1922496223 | Hope Recovery Center | Family Medicine | 9300 Shelbyville Rd Ste 506, Louisville, KY 40222-5164 | 2015-01-08 |
| 1629317391 | Burns Mack Brady | Family Medicine | 1017 W. Market St., Louisville, KY 40202 | 2013-01-31 |
| 1548533482 | Laurel County Sobriety Center Pllc | Family Medicine | 1658 East 192 Bypass, London, KY 40741 | 2012-02-22 |
| 1558328179 | Paul Wilson Craig II | Family Medicine | 6500 Highway 645, Suite 110, Inez, KY 41224 | 2006-04-27 |
| 1407856057 | Anthony Wade Alvarez | Family Medicine | 820 Dolwick Dr, Erlanger, KY 41018-2774 | 2005-07-26 |
| Find all providers with the same taxonomy | ||||
| City | PRESTONSBURG |
| Zip Code | 41653 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.