Provider Demographics
NPI:1255622023
Name:THE RENAISSANCE PARK SOUTH, LLC
Entity type:Organization
Organization Name:THE RENAISSANCE PARK SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RESIDENT ACCT & BILLING
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPSIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-745-6226
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:
Practice Address - Street 1:10935 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3127
Practice Address - Country:US
Practice Address - Phone:773-928-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0049098332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies