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General NPI Number Information
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NPI Number | 1518154871
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Entity Type | Organization
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Legal Business Name | RENAISSANCE CENTER
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 2800 WEST FULTON
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 773-722-2900
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Fax | 773-722-7662
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Provider Business Mailing Address
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Address Line | 2800 WEST FULTON
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 773-722-2900
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Fax | 773-722-7662
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Authorized Official
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Title or Position | PARTNER
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Name | MR. BRIAN CLOCH
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Credential |
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Telephone | 847-768-5114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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