1528547650 NPI number — RENAISSANCE ADULT DAY CARE INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528547650 NPI number — RENAISSANCE ADULT DAY CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAISSANCE ADULT DAY CARE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528547650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3045 COON RAPIDS BLVD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COON RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55433-3487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-433-2980
Provider Business Mailing Address Fax Number:
763-433-2982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3045 COON RAPIDS BLVD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COON RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55433-3487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-433-2980
Provider Business Practice Location Address Fax Number:
763-433-2982
Provider Enumeration Date:
08/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-898-2053

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  1028893-3-ADC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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