MEDICARE: RENACER ACLF. CORPORATION

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	3104A0625X	Assisted Living Facility (Mental Illness)	AL 7592	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881786952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENACER ACLF. CORPORATION

Provider Business Mailing Address
First Line	:	115 W 5TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4725
Country	:	US
Telephone Number	:	305-884-0611
Fax Number	:	305-884-0611

Provider Business Practice Location Address
First Line	:	115 W 5TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4725
Country	:	US
Telephone Number	:	305-884-0611
Fax Number	:	305-884-0611

Authorized Official
Title or Position	:	PRESIDENT/ADMINISTRATOR
Name	:	MS. MARILU NODARSE
Credential	:
Telephone Number	:	305-496-1513

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/21/2022

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