Provider Demographics
NPI:1346477999
Name:THE RENAISSANCE AT HILLSIDE, INC
Entity Type:Organization
Organization Name:THE RENAISSANCE AT HILLSIDE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REUVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-745-6240
Mailing Address - Street 1:7257 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1810
Mailing Address - Country:US
Mailing Address - Phone:847-933-2600
Mailing Address - Fax:847-933-2601
Practice Address - Street 1:4600 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1761
Practice Address - Country:US
Practice Address - Phone:708-544-9933
Practice Address - Fax:708-544-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0042176332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184795312OtherNPI
IL=========001Medicaid
1184795312OtherNPI