Provider Demographics
NPI:1649442963
Name:RENAISSANCE ADULT DAY IN HOME CARE SERVICES, INC
Entity type:Organization
Organization Name:RENAISSANCE ADULT DAY IN HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-723-9670
Mailing Address - Street 1:7920 S GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3318
Mailing Address - Country:US
Mailing Address - Phone:773-723-9670
Mailing Address - Fax:773-723-9677
Practice Address - Street 1:7920 S GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3318
Practice Address - Country:US
Practice Address - Phone:773-723-9670
Practice Address - Fax:773-723-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001343900000X
261QA0600X, 3416L0300X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No3416L0300XTransportation ServicesAmbulanceLand Transport