MEDICARE: RENAISSANCE CARE, 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	310400000X	Assisted Living Facility	AL12068	FL

General Provider Information

NPI Number	:	1336425271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE CARE, INC.

Provider Business Mailing Address
First Line	:	970 NW 52ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-2026
Country	:	US
Telephone Number	:	305-491-1726
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 NW 52ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-2026
Country	:	US
Telephone Number	:	305-491-1726
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	WALMATINE CRUMBLEY
Credential	:
Telephone Number	:	305-491-1726

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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