Basic Information
| Provider Information | |||||||||
| NPI: | 1346477999 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE RENAISSANCE AT HILLSIDE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7257 N LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479332600 | ||||||||
| FaxNumber: | 8479332601 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 FRONTAGE RD | ||||||||
| Address2: | |||||||||
| City: | HILLSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601621761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085449933 | ||||||||
| FaxNumber: | 7085449966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2009 | ||||||||
| LastUpdateDate: | 06/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | LEVITIN | ||||||||
| AuthorizedOfficialFirstName: | REUVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PATIENT ACCOUNTS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8477456240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 0042176 | IL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1184795312 | 01 | NPI | OTHER |