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General NPI Number Information
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NPI Number | 1144100868
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Entity Type | Organization
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Legal Business Name | RENAISSANCE RECUPERATIVE CARE L.L.C.
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 3701 AMERICAN BLVD E APT 201
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1777
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Country | US
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Telephone | 347-614-7199
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 AMERICAN BLVD E APT 201
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1777
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Country | US
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Telephone | 347-614-7199
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. JAFAR YAKUBU
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Credential | NP
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Telephone | 347-614-7199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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