Healthcare Provider Details

I. General information

NPI: 1659496966
Provider Name (Legal Business Name): SOUTHSHORE CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 E 75TH ST
CHICAGO IL
60649-3835
US

IV. Provider business mailing address

2649 E 75TH ST
CHICAGO IL
60649-3835
US

V. Phone/Fax

Practice location:
  • Phone: 773-356-9300
  • Fax: 773-356-9384
Mailing address:
  • Phone: 773-356-9300
  • Fax: 773-356-9384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0042119
License Number StateIL

VIII. Authorized Official

Name: MARK STEINBERG
Title or Position: CHIEF OPERATNG OFFICER
Credential:
Phone: 847-905-3000