Provider Demographics
NPI:1609884212
Name:RENAISSANCE CARE, INC.
Entity Type:Organization
Organization Name:RENAISSANCE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THELEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:260-637-5537
Mailing Address - Street 1:1503 CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9779
Mailing Address - Country:US
Mailing Address - Phone:260-637-5537
Mailing Address - Fax:260-637-5537
Practice Address - Street 1:1503 CARROLL RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9779
Practice Address - Country:US
Practice Address - Phone:260-637-5537
Practice Address - Fax:260-637-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services