Provider Demographics
NPI:1790197978
Name:AURORA CHICAGO LAKESHORE HOSPITAL, LLC
Entity Type:Organization
Organization Name:AURORA CHICAGO LAKESHORE HOSPITAL, LLC
Other - Org Name:AURORA CHICAGO LAKESHORE HOSPITAL CHILDREN'S PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EAKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-907-4600
Mailing Address - Street 1:4840 N MARINE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7860
Mailing Address - Country:US
Mailing Address - Phone:773-878-9700
Mailing Address - Fax:773-907-4607
Practice Address - Street 1:4720 CLARENDON ROAD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7860
Practice Address - Country:US
Practice Address - Phone:773-878-9700
Practice Address - Fax:773-907-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005207283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital