MEDICARE: RENATA'S HOME FOR THE ELDERLY 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	310400000X	Assisted Living Facility	AL 7603H	AZ

General Provider Information

NPI Number	:	1780131870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENATA'S HOME FOR THE ELDERLY LLC

Provider Business Mailing Address
First Line	:	2268 W PEGGY DR
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85142-6682
Country	:	US
Telephone Number	:	480-304-2922
Fax Number	:	480-699-7096

Provider Business Practice Location Address
First Line	:	2268 W PEGGY DR
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85142-6682
Country	:	US
Telephone Number	:	480-304-2922
Fax Number	:	480-699-7096

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. RENATA SWEDROWSKA
Credential	:
Telephone Number	:	480-304-2922

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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