Provider Demographics
NPI:1275765885
Name:RENAISSANCE HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:RENAISSANCE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMANDANG
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:213-252-8981
Mailing Address - Street 1:819 S ALVARADO ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4075
Mailing Address - Country:US
Mailing Address - Phone:213-252-8981
Mailing Address - Fax:213-252-8214
Practice Address - Street 1:819 S ALVARADO ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4075
Practice Address - Country:US
Practice Address - Phone:213-252-8981
Practice Address - Fax:213-252-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001605251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059050Medicare Oscar/Certification