Provider Demographics
NPI:1639428337
Name:THE GENESIS RENEW M & A, LLC
Entity Type:Organization
Organization Name:THE GENESIS RENEW M & A, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANAYS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICARDO
Authorized Official - Suffix:
Authorized Official - Credentials:ME
Authorized Official - Phone:239-207-0853
Mailing Address - Street 1:1059 GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2514
Mailing Address - Country:US
Mailing Address - Phone:239-207-0853
Mailing Address - Fax:239-435-1651
Practice Address - Street 1:1059 GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2514
Practice Address - Country:US
Practice Address - Phone:239-207-0853
Practice Address - Fax:239-435-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization