Healthcare Provider Details

I. General information

NPI: 1790197978
Provider Name (Legal Business Name): AURORA CHICAGO LAKESHORE HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 CLARENDON ROAD
CHICAGO IL
60640-7860
US

IV. Provider business mailing address

4840 N MARINE DR
CHICAGO IL
60640-7860
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-9700
  • Fax: 773-907-4607
Mailing address:
  • Phone: 773-878-9700
  • Fax: 773-907-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number0005207
License Number StateIL

VIII. Authorized Official

Name: MR. ALAN EAKS
Title or Position: CEO
Credential:
Phone: 773-907-4600