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NPI Code Detail

MEDICARE: RENAISSANCE AT MIDWAY INC

MEDICARE: RENAISSANCE AT MIDWAY 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
1332BN1400XNursing Facility Supplies (DME)5003380001IL
2332BP3500XParenteral & Enteral Nutrition Supplies (DME)5003380001IL
3314000000XSkilled Nursing FacilityIL

General Provider Information

NPI Number : 1487725628
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAISSANCE AT MIDWAY INC
Provider Business Mailing Address
First Line : 7257 N LINCOLN AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-1810
Country : US
Telephone Number : 847-933-2600
Fax Number : 847-933-0686
Provider Business Practice Location Address
First Line : 4437 S CICERO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4333
Country : US
Telephone Number : 773-884-0484
Fax Number : 773-884-0485
Authorized Official
Title or Position : PATIENT ACCOUNTS MANAGER
Name : REUVEN LEVITIN
Credential :
Telephone Number : 847-745-6240
Provider Enumeration Date : 11/10/2006
Last Update Date : 03/16/2009

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Directions to “RENAISSANCE AT MIDWAY INC ” Practice Location

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