NPIMap

Organization Active NPI

Wicker Park Renaissance

  • Community/Behavioral Health Agency
  • Chicago, IL
National Provider Identifier
1619620853
Registry record updated Jan 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
WICKER PARK RENAISSANCE
Practice address
1527 N Wicker Park Ave
Chicago, IL 60622-1996
Phone
(773) 645-8900
NPI assigned
Jan 28, 2022
Last updated
Jan 28, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
RENAISSANCE SOCIAL SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael BanghartNPI 1336362631
Title
Executive Director
Phone
(773) 645-8900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1527 N Wicker Park Ave
Chicago, IL 60622-1996

Mailing address

2501 W Washington Blvd Ste 401
Chicago, IL 60612-2127
Phone (773) 645-8900

Other names 1

  • Historic Wicker Park Other name

National Provider Directory

National Provider Directory
Tax ID family
Wicker Park Renaissance4 organizations share this tax ID, including this one
Part of
Wicker Park Renaissance

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643328000000",
    "number": "1619620853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 W WASHINGTON BLVD STE 401",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122127",
            "telephone_number": "773-645-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1527 N WICKER PARK AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221996",
            "telephone_number": "773-645-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKER PARK RENAISSANCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RENAISSANCE SOCIAL SERVICES, INC.",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "BANGHART",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-645-8900"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Historic Wicker Park",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.