MEDICARE: RENAISSANCE HEALTH GROUP 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1124393541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE HEALTH GROUP INC

Provider Business Mailing Address
First Line	:	3830 W HUMPHREY ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1955
Country	:	US
Telephone Number	:	813-658-3670
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 W HUMPHREY ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1955
Country	:	US
Telephone Number	:	813-658-3670
Fax Number	:	813-931-1999

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROGER PUPO
Credential	:
Telephone Number	:	813-658-3670

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	01/16/2015

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