Healthcare Provider Details

I. General information

NPI: 1720201031
Provider Name (Legal Business Name): RENAISSANCE SOCIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W WASHINGTON BLVD STE 401
CHICAGO IL
60612-2127
US

IV. Provider business mailing address

2501 W WASHINGTON BLVD STE 401
CHICAGO IL
60612-2127
US

V. Phone/Fax

Practice location:
  • Phone: 773-645-8900
  • Fax: 312-624-9849
Mailing address:
  • Phone: 773-645-8900
  • Fax: 312-624-9849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL BANGHART
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A., L.P.C.
Phone: 773-645-8900