Provider Demographics
NPI:1356729149
Name:RENEBERT SERVICES CORPORATION
Entity type:Organization
Organization Name:RENEBERT SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:AMALIA
Authorized Official - Last Name:FRIAS
Authorized Official - Suffix:
Authorized Official - Credentials:FMD
Authorized Official - Phone:954-453-1190
Mailing Address - Street 1:2455 HOLLYWOOD BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6605
Mailing Address - Country:US
Mailing Address - Phone:954-453-1190
Mailing Address - Fax:954-453-1191
Practice Address - Street 1:2455 HOLLYWOOD BLVD STE 109
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6605
Practice Address - Country:US
Practice Address - Phone:954-453-1190
Practice Address - Fax:954-453-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management