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General NPI Number Information
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NPI Number | 1407016660
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Entity Type | Organization
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Legal Business Name | RENAISSANCE ADHC AT FOOTE ST
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 5214 FOOTE STREET, NE
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City | WASHINGTON
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State | DC
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Zip | 20019
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Country | US
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Telephone | 202-388-6747
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Fax | 888-584-7137
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Provider Business Mailing Address
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Address Line | 8945 NORTH WESTLAND DRIVE #304
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City | GAITHERSBURG
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State | MD
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Zip | 20877
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Country | US
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Telephone | 240-506-6846
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. VALERYA LERA BALANNIK
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Credential |
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Telephone | 240-506-6846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | DC
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Taxonomy #2
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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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