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General NPI Number Information
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NPI Number | 1124712179
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Entity Type | Organization
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Legal Business Name | RENOVARE HEALTHCARE SERVICES INC
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 6160 N CICERO AVE STE 122
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City | CHICAGO
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State | IL
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Zip | 60646-4308
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Country | US
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Telephone | 773-417-6071
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Fax | 224-467-2170
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Provider Business Mailing Address
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Address Line | 6818 N LOWELL AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-4728
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Country | US
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Telephone | 773-417-6071
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Fax | 224-467-2170
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLUMIDE A OLUWOLE
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Credential | APRN
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Telephone | 773-392-1858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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