Provider Demographics
NPI:1457656126
Name:NORTHSHORE HOME HEALTH CORP.
Entity Type:Organization
Organization Name:NORTHSHORE HOME HEALTH CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-219-1208
Mailing Address - Street 1:6033 N KEDZIE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2406
Mailing Address - Country:US
Mailing Address - Phone:773-338-8932
Mailing Address - Fax:773-338-5957
Practice Address - Street 1:6033 N KEDZIE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2406
Practice Address - Country:US
Practice Address - Phone:773-338-8932
Practice Address - Fax:773-338-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health