Provider Demographics
NPI:1205269388
Name:RENAISSANCE CARE
Entity type:Organization
Organization Name:RENAISSANCE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOVLET
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:786-361-2273
Mailing Address - Street 1:1340 NW 207TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2331
Mailing Address - Country:US
Mailing Address - Phone:786-361-2273
Mailing Address - Fax:
Practice Address - Street 1:1340 NW 207TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2331
Practice Address - Country:US
Practice Address - Phone:786-361-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility