Provider Demographics
NPI:1801288915
Name:RENAISSANCE CARE CENTER, INC
Entity type:Organization
Organization Name:RENAISSANCE CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-674-4700
Mailing Address - Street 1:3856 OAKTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3454
Mailing Address - Country:US
Mailing Address - Phone:847-674-4700
Mailing Address - Fax:874-674-4733
Practice Address - Street 1:1675 E ASH ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-1510
Practice Address - Country:US
Practice Address - Phone:309-647-5631
Practice Address - Fax:309-647-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00402953140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric