Healthcare Provider Details

I. General information

NPI: 1730904277
Provider Name (Legal Business Name): SHORELINE LOGISTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N SANGAMON ST STE 200
CHICAGO IL
60607-2201
US

IV. Provider business mailing address

159 N SANGAMON ST STE 200
CHICAGO IL
60607-2201
US

V. Phone/Fax

Practice location:
  • Phone: 331-321-7736
  • Fax: 331-321-8766
Mailing address:
  • Phone: 331-321-7736
  • Fax: 331-321-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: JEROME SHORES
Title or Position: CEO
Credential:
Phone: 331-321-7736