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General NPI Number Information
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NPI Number | 1093534356
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Entity Type | Organization
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Legal Business Name | RENAISSANCE MEDICAL GROUP PR CORPORATION
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 406 COCO BEACH BLVD APT D402
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City | RIO GRANDE
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State | PR
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Zip | 00745-4020
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Country | US
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Telephone | 774-420-2311
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Fax | 508-462-0287
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Provider Business Mailing Address
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Address Line | 11-15 SANDERSDALE ROAD
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550-2855
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Country | US
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Telephone | 774-318-1400
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Fax | 508-462-0287
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LISSETTE GUZMAN
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Credential |
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Telephone | 774-318-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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