Provider Demographics
NPI:1184849465
Name:RENAISSANCE LABOR MGMT INC
Entity Type:Organization
Organization Name:RENAISSANCE LABOR MGMT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GHAFFARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-762-3294
Mailing Address - Street 1:PO BOX 5095
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-5095
Mailing Address - Country:US
Mailing Address - Phone:505-762-3294
Mailing Address - Fax:
Practice Address - Street 1:1501 W 7TH ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9602
Practice Address - Country:US
Practice Address - Phone:505-762-3294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========OtherEIN