Provider Demographics
NPI:1467234369
Name:RENAISSANCE VILLA ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:RENAISSANCE VILLA ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEUDONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORGEAT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-312-9654
Mailing Address - Street 1:2560 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9118
Mailing Address - Country:US
Mailing Address - Phone:386-775-4453
Mailing Address - Fax:386-775-4454
Practice Address - Street 1:2560 SHADY LN
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9118
Practice Address - Country:US
Practice Address - Phone:386-775-4453
Practice Address - Fax:386-775-4454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DL GLOBAL MANAGEMENT CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility