| Renaissance Mental Llc | |
|
18501 Pines Blvd Ste 374-375 Pembroke Pines FL 33029-1414 | |
| (786) 630-8663 | |
| Not Available |
| Full Name | Renaissance Mental Llc |
|---|---|
| Speciality | Case Management |
| Location | 18501 Pines Blvd Ste 374-375, Pembroke Pines, Florida |
| Authorized Official Name and Position | Melissa De La Cruz De La Iglesia (ADMINISTRATOR) |
| Authorized Official Contact | 7866308663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renaissance Mental Llc 18501 Pines Blvd Ste 374-375 Pembroke Pines FL 33029-1414 Ph: () - | Renaissance Mental Llc 18501 Pines Blvd Ste 374-375 Pembroke Pines FL 33029-1414 Ph: (786) 630-8663 |
| NPI Number | 1407439383 |
|---|---|
| Provider Enumeration Date | 04/29/2021 |
| Last Update Date | 06/06/2024 |
| Certification Date | 06/06/2024 |
| Medicare PECOS PAC ID | 6305233404 |
|---|---|
| Medicare Enrollment ID | O20220419003034 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407439383 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
| Provider Name | Mairelis De La Cruz Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588295919 PECOS PAC ID: 6305268491 Enrollment ID: I20200618000903 |
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