Provider Demographics
NPI:1144100868
Name:RENAISSANCE RECUPERATIVE CARE L.L.C.
Entity type:Organization
Organization Name:RENAISSANCE RECUPERATIVE CARE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-614-7199
Mailing Address - Street 1:3701 AMERICAN BLVD E APT 201
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1777
Mailing Address - Country:US
Mailing Address - Phone:347-614-7199
Mailing Address - Fax:
Practice Address - Street 1:3701 AMERICAN BLVD E APT 201
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1777
Practice Address - Country:US
Practice Address - Phone:347-614-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No251J00000XAgenciesNursing Care