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Organization

RENAISSANCE GRACE SERVICES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JEAN-CHRISTOPHE NOUKELAK SR. (ADMINISTRATOR)
(301) 979-8104
Entity
Organization

Contact information

Practice address
12009 TREGONING PL, CLARKSBURG, MD 20871-9365
(301) 979-8104
Mailing address
12009 TREGONING PL, CLARKSBURG, MD 20871-9365

Taxonomy

Speciality
Code
Description
License number
State
174200000X
Meals Provider
251E00000X
Home Health Agency
Primary
251T00000X
PACE Provider Organization
302R00000X
Health Maintenance Organization
305R00000X
Preferred Provider Organization
343900000X
Non-emergency Medical Transport (VAN)
385H00000X
Respite Care

Other

Enumeration date
03/09/2023
Last updated
03/09/2023
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