MEDICARE: RENAISSANCE CARE

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	:	1205269388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE CARE

Provider Business Mailing Address
First Line	:	1340 NW 207TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-2331
Country	:	US
Telephone Number	:	786-361-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 NW 207TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-2331
Country	:	US
Telephone Number	:	786-361-2273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NOVLET HUDSON
Credential	:	LPN
Telephone Number	:	786-361-2273

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	08/13/2013

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Directions to “RENAISSANCE CARE ” Practice Location

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