Provider Demographics
NPI:1639534829
Name:RENAISSANCE THERAPY SERVICES
Entity Type:Organization
Organization Name:RENAISSANCE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLTAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-552-6085
Mailing Address - Street 1:18710 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1052
Mailing Address - Country:US
Mailing Address - Phone:708-552-6085
Mailing Address - Fax:
Practice Address - Street 1:20200 GOVERNORS DR STE 201E
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1056
Practice Address - Country:US
Practice Address - Phone:872-205-6710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty