Healthcare Provider Details

I. General information

NPI: 1821536087
Provider Name (Legal Business Name): RENAISSANCE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 N RENAISSANCE BLVD NE
ALBUQUERQUE NM
87107-7047
US

IV. Provider business mailing address

1610 N RENAISSANCE BLVD NE
ALBUQUERQUE NM
87107-7047
US

V. Phone/Fax

Practice location:
  • Phone: 410-773-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KAM MCGAVOCK
Title or Position: PRESIDENT
Credential:
Phone: 410-773-1000