Provider Demographics
NPI:1316630296
Name:RENASCENCE PERSONAL CARE HOME LLC
Entity type:Organization
Organization Name:RENASCENCE PERSONAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAKIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JULES
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:678-979-6537
Mailing Address - Street 1:3210 TACKETT RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-9104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3845 CYPRESS CREEK PKWY STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3567
Practice Address - Country:US
Practice Address - Phone:281-645-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENASCENCE PERSONAL CARE HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)