Provider Demographics
NPI:1457445264
Name:RENAISSANCE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:RENAISSANCE ASSISTED LIVING LLC
Other - Org Name:THE RENAISSANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT MG ASSISTED LIVING INC
Authorized Official - Prefix:MR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:GELBERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-964-2828
Mailing Address - Street 1:5100 CRESTHAVEN BLVD
Mailing Address - Street 2:IN CARE OF CRESTHAVEN EAST LLC
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-8618
Mailing Address - Country:US
Mailing Address - Phone:561-964-2828
Mailing Address - Fax:561-357-5838
Practice Address - Street 1:1050 SW 24TH AVENUE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-8707
Practice Address - Country:US
Practice Address - Phone:954-360-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8697310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility