MEDICARE: RENAISSANCE HEALTHCARE, 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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1215159082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	251 FLORIDA ST
Second Line	:	SUITE 201
City	:	BATON ROUGE
State	:	LA
Zip	:	70801-1703
Country	:	US
Telephone Number	:	225-387-5585
Fax Number	:	225-387-5584

Provider Business Practice Location Address
First Line	:	251 FLORIDA ST
Second Line	:	SUITE 201
City	:	BATON ROUGE
State	:	LA
Zip	:	70801-1703
Country	:	US
Telephone Number	:	225-387-5585
Fax Number	:	225-387-5584

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES JOUBERT
Credential	:
Telephone Number	:	225-387-5585

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/22/2020

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