MEDICARE: RENAISSANCE SOCIAL 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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720201031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE SOCIAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	2501 W WASHINGTON BLVD STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2127
Country	:	US
Telephone Number	:	773-645-8900
Fax Number	:	312-624-9849

Provider Business Practice Location Address
First Line	:	2501 W WASHINGTON BLVD STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2127
Country	:	US
Telephone Number	:	773-645-8900
Fax Number	:	312-624-9849

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICHAEL BANGHART
Credential	:	M.A., L.P.C.
Telephone Number	:	773-645-8900

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	01/28/2022

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Directions to “RENAISSANCE SOCIAL SERVICES, INC. ” Practice Location

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