Provider Demographics
NPI:1609018886
Name:RENAISSANCE HEALTH SYSTEM OF FLORIDA, INC.
Entity Type:Organization
Organization Name:RENAISSANCE HEALTH SYSTEM OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUILLAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-798-9800
Mailing Address - Street 1:3420 FAIRLANE FARMS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8701
Mailing Address - Country:US
Mailing Address - Phone:561-798-9800
Mailing Address - Fax:
Practice Address - Street 1:3420 FAIRLANE FARMS RD
Practice Address - Street 2:SUITE C
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8701
Practice Address - Country:US
Practice Address - Phone:561-798-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAISSANCE HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management