Provider Demographics
NPI:1225641368
Name:RENAISSANCE GAINESVILLE 1, LLC
Entity Type:Organization
Organization Name:RENAISSANCE GAINESVILLE 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-228-8131
Mailing Address - Street 1:12933 W HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9107
Mailing Address - Country:US
Mailing Address - Phone:502-228-8131
Mailing Address - Fax:502-228-1940
Practice Address - Street 1:2215 OLD HAMILTON PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-7893
Practice Address - Country:US
Practice Address - Phone:470-691-0161
Practice Address - Fax:770-297-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility