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General NPI Number Information
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NPI Number | 1326116385
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Entity Type | Organization
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Legal Business Name | RENAISSANCE HEALTHCARE INC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 750 TERRADO PLAZA SUITE 119
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City | COVINA
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State | CA
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Zip | 91723-3411
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Country | US
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Telephone | 909-623-9972
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Fax | 909-623-9970
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Provider Business Mailing Address
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Address Line | 750 TERRADO PLAZA SUITE 119
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City | COVINA
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State | CA
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Zip | 91723-3411
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Country | US
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Telephone | 909-623-9972
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Fax | 909-623-9970
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CORAZON C APO
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Credential | BSN
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Telephone | 909-623-9972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 980001493
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License Number State | CA
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