5065 Wallis Road Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1198096 Issued in FL

Legal business name

5065 WALLIS ROAD OPERATIONS LLC

Doing business as

Renaissance Health and Rehabilitation

Practice address

5065 Wallis Rd
West Palm Beach, FL 33415-1947

Phone

(561) 689-1799

Fax

(561) 640-4603

NPI assigned

Dec 27, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth Ussery

Title

VP

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Renaissance Health and Rehabilitation Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1891064549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5065 WALLIS RD",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334151947",
            "telephone_number": "561-689-1799",
            "fax_number": "561-640-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5065 WALLIS RD",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334151947",
            "telephone_number": "561-689-1799",
            "fax_number": "561-640-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "5065 WALLIS ROAD OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-27",
        "last_updated": "2023-11-27",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "USSERY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "407-571-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1198096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004778700",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S Ste 200",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Renaissance Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renaissance Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 365 Home Healthcare LLC
• 4 The Kingdom Cleaners LLC (4 The Kingdom Home Care LLC)
• 45TH St Pain Management LLC
• 4Hearts Medical Transport, LLC
• 5 Star Industries Inc.
• A & Associates Int Inc (A&A Compassionate Companions)
• A & L Behavior Therapy
• A Accident Injury, and Pain Relief Clinic
• A Better Solution Recovery
• A Better Solution Recovery LLC

• Skilled Nursing Facility in West Palm Beach, FL
• Providers in West Palm Beach, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.