Provider Demographics
NPI:1316237191
Name:NORTHSHORE UNIVERSITY HEALTHSYSTEM HOME AND HOSPICE SERVICES
Entity type:Organization
Organization Name:NORTHSHORE UNIVERSITY HEALTHSYSTEM HOME AND HOSPICE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-570-2000
Mailing Address - Street 1:24793 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1247
Mailing Address - Country:US
Mailing Address - Phone:847-475-3646
Mailing Address - Fax:
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:60077-5314
Practice Address - Country:US
Practice Address - Phone:847-475-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1008788332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2585310001Medicare NSC