Healthcare Provider Details

I. General information

NPI: 1407016660
Provider Name (Legal Business Name): RENAISSANCE ADHC AT FOOTE ST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 FOOTE STREET, NE
WASHINGTON DC
20019
US

IV. Provider business mailing address

8945 NORTH WESTLAND DRIVE #304
GAITHERSBURG MD
20877
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-6747
  • Fax: 888-584-7137
Mailing address:
  • Phone: 240-506-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALERYA LERA BALANNIK
Title or Position: PARTNER
Credential:
Phone: 240-506-6846