MEDICARE: RENE'S CARE FACILITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QH0100X	Health Service Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
4	324500000X	Substance Abuse Rehabilitation Facility
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1093664120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENE'S CARE FACILITY LLC

Provider Business Mailing Address
First Line	:	4040 E MCDOWELL RD STE 211
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4438
Country	:	US
Telephone Number	:	602-471-3769
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 E MCDOWELL RD STE 211
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4438
Country	:	US
Telephone Number	:	602-471-3769
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VALERIE BULLOCK
Credential	:
Telephone Number	:	510-772-1117

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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