Healthcare Provider Details

I. General information

NPI: 1407280381
Provider Name (Legal Business Name): RENAISSANCE ADULT DAY SERVICES-787EAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 E 156TH ST
BRONX NY
10455-1713
US

IV. Provider business mailing address

787 E 156TH ST
BRONX NY
10455-1713
US

V. Phone/Fax

Practice location:
  • Phone: 718-649-3670
  • Fax: 718-649-3671
Mailing address:
  • Phone: 718-649-3670
  • Fax: 718-649-3671

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: MRS. EILEEN PARENTI
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, BSN
Phone: 718-649-3670