Provider Demographics
NPI:1164829966
Name:RENACER ALF LLC
Entity Type:Organization
Organization Name:RENACER ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWE
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-453-3062
Mailing Address - Street 1:7616 OCEAN HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1518
Mailing Address - Country:US
Mailing Address - Phone:813-453-3062
Mailing Address - Fax:
Practice Address - Street 1:8250 MALVERN CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2243
Practice Address - Country:US
Practice Address - Phone:813-249-0286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility