MEDICARE: RENAISSANCE HEALTHCARE GROUP 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	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1982580734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE HEALTHCARE GROUP LLC

Provider Business Mailing Address
First Line	:	2600 LAKE LUCIEN DR STE 210
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7275
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 PASADENA PL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-3825
Country	:	US
Telephone Number	:	954-284-0495
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BENJAMIN BRADY
Credential	:
Telephone Number	:	615-864-8145

Provider Enumeration Date	:	08/14/2025
Last Update Date	:	04/06/2026

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