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NPI Code Detail

MEDICARE: RENAISSANCE PARK SOUTH, LLC

MEDICARE: RENAISSANCE PARK SOUTH, LLC
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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1629278346
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAISSANCE PARK SOUTH, LLC
Provider Business Mailing Address
First Line : 7257 N. LINCOLN AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712
Country : US
Telephone Number : 847-933-2600
Fax Number : 773-928-9670
Provider Business Practice Location Address
First Line : 10935 S HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-3127
Country : US
Telephone Number : 773-928-2000
Fax Number : 773-928-9670
Authorized Official
Title or Position : MANAGER
Name : MR. DAVID HARTMAN
Credential :
Telephone Number : 847-933-2600
Provider Enumeration Date : 07/20/2007
Last Update Date : 08/13/2015

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Directions to “RENAISSANCE PARK SOUTH, LLC ” Practice Location

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