MEDICARE: RENAISSANCE INTERNATIONAL 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	T8SX	MA

General Provider Information

NPI Number	:	1144234097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE INTERNATIONAL GROUP INC.

Provider Business Mailing Address
First Line	:	103 BLAKE ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02126-1602
Country	:	US
Telephone Number	:	617-416-0220
Fax Number	:	617-276-3517

Provider Business Practice Location Address
First Line	:	103 BLAKE ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02126-1602
Country	:	US
Telephone Number	:	617-416-0220
Fax Number	:	617-276-3517

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BEDE EBUZO MBAWUIKE
Credential	:
Telephone Number	:	617-416-0220

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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