Provider Demographics
NPI:1588227995
Name:NORTH SHORE RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:NORTH SHORE RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-933-5418
Mailing Address - Street 1:580 NORTH STATE ROUTE 741
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8839
Mailing Address - Country:US
Mailing Address - Phone:513-933-5401
Mailing Address - Fax:513-932-1054
Practice Address - Street 1:9400 NORTH SHORE BOULEVARD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:OH
Practice Address - Zip Code:43440-1337
Practice Address - Country:US
Practice Address - Phone:419-798-8203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH SHORE RETIREMENT COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility