Provider Demographics
NPI:1790823730
Name:RENAISSANCE HOME HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:RENAISSANCE HOME HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMENCITA
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:AGNO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-939-5250
Mailing Address - Street 1:500 E. HIGGINS ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007
Mailing Address - Country:US
Mailing Address - Phone:847-939-5250
Mailing Address - Fax:847-939-5252
Practice Address - Street 1:500 E. HIGGINS ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007
Practice Address - Country:US
Practice Address - Phone:847-939-5250
Practice Address - Fax:847-939-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011224163WH0200X
IL1007475251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147636Medicare Oscar/Certification