Provider Demographics
NPI:1245985027
Name:JR RENAISSANCE HEALTH SERVICES
Entity type:Organization
Organization Name:JR RENAISSANCE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-234-3834
Mailing Address - Street 1:PO BOX 90182
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89009-0182
Mailing Address - Country:US
Mailing Address - Phone:928-234-3834
Mailing Address - Fax:602-792-7270
Practice Address - Street 1:1957 HWAY 95 STE 23
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6744
Practice Address - Country:US
Practice Address - Phone:928-234-3834
Practice Address - Fax:602-792-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center