Provider Demographics
NPI:1750261590
Name:THERENAISSANCEGROUPREALTY LLC
Entity type:Organization
Organization Name:THERENAISSANCEGROUPREALTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-237-2137
Mailing Address - Street 1:14116 CASTLE BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4654
Mailing Address - Country:US
Mailing Address - Phone:571-237-2137
Mailing Address - Fax:571-237-2137
Practice Address - Street 1:123 FIELDSTONE CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-3279
Practice Address - Country:US
Practice Address - Phone:571-237-2137
Practice Address - Fax:571-237-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty