MEDICARE: RENAISSANCE CARE CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0040295	IL

General Provider Information

NPI Number	:	1063473635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE CARE CENTER, INC

Provider Business Mailing Address
First Line	:	3856 OAKTON ST
Second Line	:	SUITE 200
City	:	SKOKIE
State	:	IL
Zip	:	60076-3454
Country	:	US
Telephone Number	:	847-674-4700
Fax Number	:	847-674-4733

Provider Business Practice Location Address
First Line	:	1675 E ASH ST
Second Line	:
City	:	CANTON
State	:	IL
Zip	:	61520-1510
Country	:	US
Telephone Number	:	309-647-5631
Fax Number	:	309-647-8957

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRADLEY ALTER
Credential	:
Telephone Number	:	847-674-4700

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/30/2016

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