Healthcare Provider Details

I. General information

NPI: 1538324801
Provider Name (Legal Business Name): RENASSAINCE RETIREMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W AIRPORT BLVD
SANFORD FL
32773-8000
US

IV. Provider business mailing address

300 W AIRPORT BLVD
SANFORD FL
32773-8000
US

V. Phone/Fax

Practice location:
  • Phone: 407-323-7306
  • Fax: 407-323-7336
Mailing address:
  • Phone: 407-323-7306
  • Fax: 407-323-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number05815
License Number StateFL

VIII. Authorized Official

Name: MS. DELILAH TERRANOVA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-323-7306