Healthcare Provider Details

I. General information

NPI: 1144100868
Provider Name (Legal Business Name): RENAISSANCE RECUPERATIVE CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 AMERICAN BLVD E APT 201
BLOOMINGTON MN
55425-1777
US

IV. Provider business mailing address

3701 AMERICAN BLVD E APT 201
BLOOMINGTON MN
55425-1777
US

V. Phone/Fax

Practice location:
  • Phone: 347-614-7199
  • Fax:
Mailing address:
  • Phone: 347-614-7199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAFAR YAKUBU
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 347-614-7199