Provider Demographics
NPI:1306415765
Name:RENAISSANCE CARE LLC
Entity Type:Organization
Organization Name:RENAISSANCE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYAZI
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:732-491-3619
Mailing Address - Street 1:55 DAVIDSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4751
Mailing Address - Country:US
Mailing Address - Phone:732-491-3619
Mailing Address - Fax:
Practice Address - Street 1:55 DAVIDSON MILL RD
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4751
Practice Address - Country:US
Practice Address - Phone:732-491-3619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management