Provider Demographics
NPI:1235300534
Name:RENAISSANCE 1 SOCIAL SERVICES, LLC
Entity Type:Organization
Organization Name:RENAISSANCE 1 SOCIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HERLANIUS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-243-1901
Mailing Address - Street 1:5705 ST. ROCH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122
Mailing Address - Country:US
Mailing Address - Phone:504-243-1901
Mailing Address - Fax:504-243-1903
Practice Address - Street 1:5705 ST. ROCH AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122
Practice Address - Country:US
Practice Address - Phone:504-243-1901
Practice Address - Fax:504-243-1903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10624251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1473600Medicaid