=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063368280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORELINE BEHAVIORAL OF ILLINOIS, PROFESSIONAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2026
-----------------------------------------------------
Last Update Date | 03/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2942 W AUGUSTA BLVD APT 3
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-2786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-537-6153
-----------------------------------------------------
Fax | 772-264-8329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2942 W AUGUSTA BLVD APT 3
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-2786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-537-6153
-----------------------------------------------------
Fax | 772-264-8329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. NADINE DABBS
-----------------------------------------------------
Credential | M.S., BCBA, LBA
-----------------------------------------------------
Telephone | 561-537-6153
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------