Provider Demographics
NPI:1851800015
Name:GAHC4 RENAISSANCE FL TRS SUB, LLC
Entity Type:Organization
Organization Name:GAHC4 RENAISSANCE FL TRS SUB, LLC
Other - Org Name:RENAISSANCE RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-270-9200
Mailing Address - Street 1:18191 VON KARMAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-7106
Mailing Address - Country:US
Mailing Address - Phone:949-270-9200
Mailing Address - Fax:
Practice Address - Street 1:300 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-8000
Practice Address - Country:US
Practice Address - Phone:407-995-6224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility