Healthcare Provider Details

I. General information

NPI: 1831590355
Provider Name (Legal Business Name): RENAISSANCE ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 EDDY ST
PROVIDENCE RI
02905-4607
US

IV. Provider business mailing address

1090 EDDY ST
PROVIDENCE RI
02905-4607
US

V. Phone/Fax

Practice location:
  • Phone: 401-640-7648
  • Fax:
Mailing address:
  • Phone: 401-640-7648
  • 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: ERNY FRANCISCO
Title or Position: VICE-PRESIDENT
Credential:
Phone: 401-640-7648