Provider Demographics
NPI:1093534356
Name:RENAISSANCE MEDICAL GROUP PR CORPORATION
Entity type:Organization
Organization Name:RENAISSANCE MEDICAL GROUP PR CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-318-1400
Mailing Address - Street 1:11-15 SANDERSDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-2855
Mailing Address - Country:US
Mailing Address - Phone:774-318-1400
Mailing Address - Fax:508-462-0287
Practice Address - Street 1:406 COCO BEACH BLVD APT D402
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-4020
Practice Address - Country:US
Practice Address - Phone:774-420-2311
Practice Address - Fax:508-462-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care