Provider Demographics
NPI:1093101941
Name:RENAISSANCE COACHING, LLC
Entity Type:Organization
Organization Name:RENAISSANCE COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TCM SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:NERY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-293-0041
Mailing Address - Street 1:1181 19TH ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-4435
Mailing Address - Country:US
Mailing Address - Phone:239-293-0041
Mailing Address - Fax:
Practice Address - Street 1:11725 COLLIER BLVD
Practice Address - Street 2:SUITE A-2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-6524
Practice Address - Country:US
Practice Address - Phone:239-293-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty