Healthcare Provider Details

I. General information

NPI: 1700492014
Provider Name (Legal Business Name): KINDRED THC NORTH SHORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 W MELROSE ST
CHICAGO IL
60641-4799
US

IV. Provider business mailing address

4058 W MELROSE ST
CHICAGO IL
60641-4799
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-7000
  • Fax: 773-202-4355
Mailing address:
  • Phone: 773-736-7000
  • Fax: 773-202-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: TERRANCE K DILLON
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7220