Provider Demographics
NPI:1194216408
Name:THE NORTH SHORE IV CENTER
Entity Type:Organization
Organization Name:THE NORTH SHORE IV CENTER
Other - Org Name:RADEN IV CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:RECEPTION
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-964-0326
Mailing Address - Street 1:200 GREEN BAY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1703
Mailing Address - Country:US
Mailing Address - Phone:847-964-0326
Mailing Address - Fax:
Practice Address - Street 1:200 GREEN BAY RD FL 2
Practice Address - Street 2:
Practice Address - City:HIGHWOOD
Practice Address - State:IL
Practice Address - Zip Code:60040-1703
Practice Address - Country:US
Practice Address - Phone:847-964-0326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042620773261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy