# RENAISSANCE MEDICAL GROUP PR CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Renaissance Medical Group PR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093534356
- **Authorized official:** LISSETTE GUZMAN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (774) 318-1400

## Contact information

- **Practice address:** 406 COCO BEACH BLVD APT D402, RIO GRANDE, PR 00745-4020
- **Practice address phone:** (774) 420-2311
- **Practice address fax:** (508) 462-0287
- **Mailing address:** 11-15 SANDERSDALE ROAD, SOUTHBRIDGE, MA 01550-2855
- **Mailing address phone:** (774) 318-1400
- **Mailing address fax:** (508) 462-0287

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |

## Other

- **Enumeration date:** 10/04/2024
- **Last updated:** 07/15/2025