Healthcare Provider Details

I. General information

NPI: 1871651588
Provider Name (Legal Business Name): SOUTH SHORE HOME HEALTH SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 VETERANS HWY STE B15
RONKONKOMA NY
11779-7665
US

IV. Provider business mailing address

801 WARRENVILLE RD STE 800
LISLE IL
60532-0912
US

V. Phone/Fax

Practice location:
  • Phone: 631-567-6555
  • Fax:
Mailing address:
  • Phone: 630-296-3400
  • Fax: 630-487-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0318L001
License Number StateNY

VIII. Authorized Official

Name: DARBY ANDERSON
Title or Position: EVP CHIEF STRATEGY OFFICER
Credential:
Phone: 630-296-3443