Healthcare Provider Details

I. General information

NPI: 1760315329
Provider Name (Legal Business Name): THE RENAISSANCE ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9727 W DEMAR AVE
WASILLA AK
99623-4957
US

IV. Provider business mailing address

PO BOX 877531
WASILLA AK
99687-7531
US

V. Phone/Fax

Practice location:
  • Phone: 907-310-1560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID MCCARTHY
Title or Position: MEMBER/ADMINISTRATOR
Credential:
Phone: 907-310-1560