Provider Demographics
NPI:1437106077
Name:NORTHSHORE UNIVERSITY HEALTHSYSTEM
Entity Type:Organization
Organization Name:NORTHSHORE UNIVERSITY HEALTHSYSTEM
Other - Org Name:NORTHSHORE UNIVERSITY HEALTHSYSTEM HOME & HOSPICE SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-570-5099
Mailing Address - Street 1:1301 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1613
Mailing Address - Country:US
Mailing Address - Phone:847-570-2000
Mailing Address - Fax:847-570-5240
Practice Address - Street 1:4901 SEARLE PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-5313
Practice Address - Country:US
Practice Address - Phone:847-475-2001
Practice Address - Fax:847-328-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-12-06
Deactivation Date:2022-07-20
Deactivation Code:
Reactivation Date:2022-12-06
Provider Licenses
StateLicense IDTaxonomies
IL1008754251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
147001Medicare ID - Type Unspecified