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General NPI Number Information
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NPI Number | 1144106667
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Entity Type | Organization
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Legal Business Name | RENAISSANCE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location 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 | 774-420-2311
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Fax | 508-519-0763
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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 | 774-420-2311
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Fax | 508-519-0763
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Authorized Official
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Title or Position | OWNER/ CEO
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Name | JESUS D SUAREZ
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Credential |
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Telephone | 774-420-2311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 174200000X
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Taxonomy Name | Meals Provider
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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