MEDICARE: RENAISSANCE ADULT DAY IN HOME CARE SERVICES, 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	343900000X	Non-emergency Medical Transport (VAN)	001	IL
2	261QA0600X	Adult Day Care Clinic/Center
3	3416L0300X	Land Ambulance
4	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1649442963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE ADULT DAY IN HOME CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	7920 S GREENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3318
Country	:	US
Telephone Number	:	773-723-9670
Fax Number	:	773-723-9677

Provider Business Practice Location Address
First Line	:	7920 S GREENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3318
Country	:	US
Telephone Number	:	773-723-9670
Fax Number	:	773-723-9677

Authorized Official
Title or Position	:	PROGRAM ADMINISTRATOR
Name	:	MR. MELVIN E. HICKS
Credential	:
Telephone Number	:	773-723-9670

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	07/21/2022

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