Healthcare Provider Details

I. General information

NPI: 1912259425
Provider Name (Legal Business Name): NORTH SHORE SENIOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 NORTHFIELD RD
NORTHFIELD IL
60093-3309
US

IV. Provider business mailing address

161 NORTHFIELD RD
NORTHFIELD IL
60093-3309
US

V. Phone/Fax

Practice location:
  • Phone: 847-784-6000
  • Fax:
Mailing address:
  • Phone: 847-784-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MR. JORDAN LUHR
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 847-784-6027