Healthcare Provider Details

I. General information

NPI: 1720661499
Provider Name (Legal Business Name): RENAISSANCE ADULT MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 REISTERSTOWN RD
PIKESVILLE MD
21208-4207
US

IV. Provider business mailing address

1017 REISTERSTOWN RD
PIKESVILLE MD
21208-4207
US

V. Phone/Fax

Practice location:
  • Phone: 410-580-9301
  • Fax:
Mailing address:
  • Phone: 410-580-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JULIE RAKHAMIMOV
Title or Position: OWNER
Credential:
Phone: 443-838-0007