Provider Demographics
NPI:1124319405
Name:THE RENAISSANCE AT 87TH STREET INC
Entity type:Organization
Organization Name:THE RENAISSANCE AT 87TH STREET INC
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 1:2940 W 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3832
Practice Address - Country:US
Practice Address - Phone:773-434-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0042093332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies