Provider Demographics
NPI:1215269071
Name:RENAISSANCE SAINT LUKE SLF LP
Entity type:Organization
Organization Name:RENAISSANCE SAINT LUKE SLF LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FACILTY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FICKENSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-525-1501
Mailing Address - Street 1:2001 W CHURCHILL ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5503
Mailing Address - Country:US
Mailing Address - Phone:773-278-8448
Mailing Address - Fax:773-278-7724
Practice Address - Street 1:1501 W MELROSE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9083
Practice Address - Country:US
Practice Address - Phone:773-525-1501
Practice Address - Fax:773-269-6667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAISSANCE SAINT LUKE SLF LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility