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NPI Code Detail

MEDICARE: SOUTHSHORE CARE CENTER, LLC

MEDICARE: SOUTHSHORE CARE CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility0042119IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11193OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1659496966
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHSHORE CARE CENTER, LLC
Provider Business Mailing Address
First Line : 2649 E 75TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60649-3835
Country : US
Telephone Number : 773-356-9300
Fax Number : 773-356-9384
Provider Business Practice Location Address
First Line : 2649 E 75TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60649-3835
Country : US
Telephone Number : 773-356-9300
Fax Number : 773-356-9384
Authorized Official
Title or Position : CHIEF OPERATNG OFFICER
Name : MARK STEINBERG
Credential :
Telephone Number : 847-905-3000
Provider Enumeration Date : 03/20/2007
Last Update Date : 08/22/2020

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Directions to “SOUTHSHORE CARE CENTER, LLC ” Practice Location

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