MEDICARE: RENNES ASSISTED LIVING CORP.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	14498	WI

General Provider Information

NPI Number	:	1396130498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENNES ASSISTED LIVING CORP.

Provider Business Mailing Address
First Line	:	2909 SHORE DR
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143-4237
Country	:	US
Telephone Number	:	715-735-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 SHORE DR
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143-4237
Country	:	US
Telephone Number	:	715-735-2100
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	NEIL JOHNSON
Credential	:
Telephone Number	:	715-582-2200

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	04/06/2015

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