Provider Demographics
NPI:1922053909
Name:RENAISSANCE CMHC
Entity Type:Organization
Organization Name:RENAISSANCE CMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:305-654-4044
Mailing Address - Street 1:995 NE 124TH ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5744
Mailing Address - Country:US
Mailing Address - Phone:305-654-4044
Mailing Address - Fax:305-654-4416
Practice Address - Street 1:995 NE 124TH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5744
Practice Address - Country:US
Practice Address - Phone:305-654-4044
Practice Address - Fax:305-654-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-1433Medicare ID - Type UnspecifiedCMHC