MEDICARE: RENIASANCE HEALTHCARE SERVICE

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	332B00000X	Durable Medical Equipment & Medical Supplies		TX

General Provider Information

NPI Number	:	1619158037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENIASANCE HEALTHCARE SERVICE

Provider Business Mailing Address
First Line	:	7111 HARWIN DR
Second Line	:	SUITE NO 218
City	:	HOUSTON
State	:	TX
Zip	:	77036-2129
Country	:	US
Telephone Number	:	832-785-2300
Fax Number	:	713-972-3800

Provider Business Practice Location Address
First Line	:	7111 HARWIN DR
Second Line	:	SUITE NO 218
City	:	HOUSTON
State	:	TX
Zip	:	77036-2129
Country	:	US
Telephone Number	:	832-785-2300
Fax Number	:	713-972-3800

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DON/CHUKWU O/L NDUKWE/KALU
Credential	:
Telephone Number	:	281-785-2300

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	07/21/2022

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