Provider Demographics
NPI:1760540470
Name:HOME HEALTHCARE RENEWAL SERVICES, INC.
Entity Type:Organization
Organization Name:HOME HEALTHCARE RENEWAL SERVICES, INC.
Other - Org Name:HOME HEALTH CARE RENEWAL SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STORI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:815-513-5929
Mailing Address - Street 1:105 E MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-2138
Mailing Address - Country:US
Mailing Address - Phone:815-513-5929
Mailing Address - Fax:708-252-3816
Practice Address - Street 1:105 E MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-2138
Practice Address - Country:US
Practice Address - Phone:815-513-5929
Practice Address - Fax:708-252-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1002609251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9780OtherBLUE CROSS BLUE SHIELD IL
IL10132045OtherBLUE CROSS BLUE SHIELD IL
IL10132045OtherBLUE CROSS BLUE SHIELD IL
IL10132045OtherBLUE CROSS BLUE SHIELD IL
IL10132045OtherBLUE CROSS BLUE SHIELD IL