Provider Demographics
NPI:1316000623
Name:RENAISSANCE MEDICAL STAFFING, LLC
Entity Type:Organization
Organization Name:RENAISSANCE MEDICAL STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPA & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:OMOLO
Authorized Official - Last Name:BLASIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-293-1976
Mailing Address - Street 1:3265 FIDDLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811
Mailing Address - Country:US
Mailing Address - Phone:317-293-1976
Mailing Address - Fax:
Practice Address - Street 1:8201 TRADERS HOLLOW CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1297
Practice Address - Country:US
Practice Address - Phone:317-293-1976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health