Provider Demographics
NPI:1144314949
Name:RENAISSANCE CARE LLC
Entity type:Organization
Organization Name:RENAISSANCE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-220-1616
Mailing Address - Street 1:20220 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3501
Mailing Address - Country:US
Mailing Address - Phone:440-409-0312
Mailing Address - Fax:440-409-0322
Practice Address - Street 1:3841 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3099
Practice Address - Country:US
Practice Address - Phone:330-220-1616
Practice Address - Fax:330-220-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-83542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2456524Medicaid
OH4121167Medicare ID - Type UnspecifiedPROVIDER
OH2456524Medicaid