Provider Demographics
NPI:1356343396
Name:RENAISSANCE HOME HEALTH CARE INC.
Entity type:Organization
Organization Name:RENAISSANCE HOME HEALTH CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:EGBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:619-285-1505
Mailing Address - Street 1:3160 CAMINO DEL RIO S STE 312
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3835
Mailing Address - Country:US
Mailing Address - Phone:619-285-1505
Mailing Address - Fax:619-285-1605
Practice Address - Street 1:3160 CAMINO DEL RIO S STE 312
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3835
Practice Address - Country:US
Practice Address - Phone:619-285-1505
Practice Address - Fax:619-285-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000782251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080000782OtherHOME HEALTH LICENSE
CAHHA08281FMedicaid
058281Medicare Oscar/Certification
CA080000782OtherHOME HEALTH LICENSE
CAHHA08281FMedicaid