Healthcare Provider Details

I. General information

NPI: 1194880310
Provider Name (Legal Business Name): THSC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 N WINCHESTER AVE
CHICAGO IL
60640-5265
US

IV. Provider business mailing address

4501 N WINCHESTER AVE
CHICAGO IL
60640-5265
US

V. Phone/Fax

Practice location:
  • Phone: 773-250-0000
  • Fax: 773-250-0497
Mailing address:
  • Phone: 773-250-0000
  • Fax: 773-250-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1820486
License Number StateIL

VIII. Authorized Official

Name: DENISE CAMERON
Title or Position: VP MANAGED CARE
Credential:
Phone: 773-250-1119