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NPI Code Detail

MEDICARE: RENAISSANCE CARE INC

MEDICARE: RENAISSANCE CARE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency2804009000WV
2253Z00000XIn Home Supportive Care Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104941921
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAISSANCE CARE INC
Provider Business Mailing Address
First Line : PO BOX 745
Second Line :
City : DELLSLOW
State : WV
Zip : 26531-0745
Country : US
Telephone Number : 304-292-6880
Fax Number : 304-292-6881
Provider Business Practice Location Address
First Line : 219 HARTMAN RUN RD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-5377
Country : US
Telephone Number : 304-292-6880
Fax Number : 304-292-6881
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. REBECCA M DEEM
Credential :
Telephone Number : 304-292-6880
Provider Enumeration Date : 03/20/2007
Last Update Date : 11/10/2023

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1871455634 — KRISTIN G CAIN
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Directions to “RENAISSANCE CARE INC ” Practice Location

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