MEDICARE: RENACER ALF LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1164829966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENACER ALF LLC

Provider Business Mailing Address
First Line	:	7616 OCEAN HARBOR LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1518
Country	:	US
Telephone Number	:	813-453-3062
Fax Number	:

Provider Business Practice Location Address
First Line	:	8250 MALVERN CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2243
Country	:	US
Telephone Number	:	813-249-0286
Fax Number	:

Authorized Official
Title or Position	:	OWNWE
Name	:	ROSA PEREZ
Credential	:
Telephone Number	:	813-453-3062

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	11/24/2014

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