Healthcare Provider Details

I. General information

NPI: 1649442963
Provider Name (Legal Business Name): RENAISSANCE ADULT DAY IN HOME CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 S GREENWOOD AVE
CHICAGO IL
60619-3318
US

IV. Provider business mailing address

7920 S GREENWOOD AVE
CHICAGO IL
60619-3318
US

V. Phone/Fax

Practice location:
  • Phone: 773-723-9670
  • Fax: 773-723-9677
Mailing address:
  • Phone: 773-723-9670
  • Fax: 773-723-9677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number001
License Number StateIL

VIII. Authorized Official

Name: MR. MELVIN E. HICKS
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 773-723-9670