Provider Demographics
NPI:1972885325
Name:SOUTH SHORE MED & REHAB CENTER
Entity Type:Organization
Organization Name:SOUTH SHORE MED & REHAB CENTER
Other - Org Name:ACCESS THERAPY, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-842-6433
Mailing Address - Street 1:2600 S MICHIGAN AVE
Mailing Address - Street 2:SUITE LL-B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2857
Mailing Address - Country:US
Mailing Address - Phone:312-842-6433
Mailing Address - Fax:312-842-6201
Practice Address - Street 1:2600 S MICHIGAN AVE
Practice Address - Street 2:SUITE LL-B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2857
Practice Address - Country:US
Practice Address - Phone:312-842-6433
Practice Address - Fax:312-842-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy