Provider Demographics
NPI:1760015556
Name:RENLIV MANOR ALF LLC
Entity Type:Organization
Organization Name:RENLIV MANOR ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:EUGENE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-509-4054
Mailing Address - Street 1:17930 62ND RD N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3217
Mailing Address - Country:US
Mailing Address - Phone:561-509-4054
Mailing Address - Fax:
Practice Address - Street 1:17930 62ND RD N
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3217
Practice Address - Country:US
Practice Address - Phone:561-509-4054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility