MEDICARE: RENAISSANCE 1 SOCIAL SERVICES, LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1538881263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE 1 SOCIAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	5705 SAINT ROCH AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-5333
Country	:	US
Telephone Number	:	504-243-1901
Fax Number	:	504-243-1903

Provider Business Practice Location Address
First Line	:	5705 SAINT ROCH AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-5333
Country	:	US
Telephone Number	:	504-243-1901
Fax Number	:	504-243-1903

Authorized Official
Title or Position	:	OWNER
Name	:	MS. HERLANIUS TATE
Credential	:
Telephone Number	:	504-654-6137

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	09/19/2022

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