Healthcare Provider Details

I. General information

NPI: 1598635104
Provider Name (Legal Business Name): RENEWAL LIFE COMMUNITY DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2025
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 S EMERALD AVE
CHICAGO IL
60621-2814
US

IV. Provider business mailing address

5848 S EMERALD AVE
CHICAGO IL
60621-2814
US

V. Phone/Fax

Practice location:
  • Phone: 872-352-0096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JERICO BEOWN
Title or Position: OWNER
Credential:
Phone: 872-352-0096