Provider Demographics
NPI:1861752297
Name:RENAISSANCE HEALTHCARE SYSTEM, LLC.
Entity type:Organization
Organization Name:RENAISSANCE HEALTHCARE SYSTEM, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GETHERS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:215-290-6377
Mailing Address - Street 1:3216 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-2416
Mailing Address - Country:US
Mailing Address - Phone:215-290-6377
Mailing Address - Fax:
Practice Address - Street 1:3216 TURNER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2416
Practice Address - Country:US
Practice Address - Phone:215-290-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
PAPT002677L225100000X
PAOC010160225X00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017875630001Medicaid
PA1026557740001Medicaid