Provider Demographics
NPI:1336425271
Name:RENAISSANCE CARE, INC.
Entity Type:Organization
Organization Name:RENAISSANCE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WALMATINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-491-1726
Mailing Address - Street 1:970 NW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-2026
Mailing Address - Country:US
Mailing Address - Phone:305-491-1726
Mailing Address - Fax:
Practice Address - Street 1:970 NW 52ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-2026
Practice Address - Country:US
Practice Address - Phone:305-491-1726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12068310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility