MEDICARE: MDESARMES LLC DBA RENAISSANCE CLINIC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1346133543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDESARMES LLC DBA RENAISSANCE CLINIC

Provider Business Mailing Address
First Line	:	6565 TAFT ST STE 406
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4002
Country	:	US
Telephone Number	:	561-576-3074
Fax Number	:	561-557-7380

Provider Business Practice Location Address
First Line	:	6565 TAFT ST # 406
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4002
Country	:	US
Telephone Number	:	561-576-3074
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. MICHELLE R DESARMES
Credential	:
Telephone Number	:	561-576-3074

Provider Enumeration Date	:	05/29/2025
Last Update Date	:	11/19/2025

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