=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457656126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHSHORE HOME HEALTH CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2011
-----------------------------------------------------
Last Update Date | 01/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6033 N KEDZIE AVE SUITE 101
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60659-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-338-8932
-----------------------------------------------------
Fax | 773-338-5957
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6033 N KEDZIE AVE SUITE 101
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60659-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-338-8932
-----------------------------------------------------
Fax | 773-338-5957
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY SUPERVISOR
-----------------------------------------------------
Name | SUSAN GRACE SANCHEZ
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 847-219-1208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------