Provider Demographics
NPI:1124712179
Name:RENOVARE HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:RENOVARE HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUMIDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLUWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:773-392-1858
Mailing Address - Street 1:6818 N LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-4728
Mailing Address - Country:US
Mailing Address - Phone:773-417-6071
Mailing Address - Fax:224-467-2170
Practice Address - Street 1:6160 N CICERO AVE STE 122
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4308
Practice Address - Country:US
Practice Address - Phone:773-417-6071
Practice Address - Fax:224-467-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty