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General NPI Number Information
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NPI Number | 1760605000
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Entity Type | Organization
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Legal Business Name | NORTH SHORE RETIREMENT COMMUNITY
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 9400 E NORTHSHORE BLVD
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City | LAKESIDE
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State | OH
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Zip | 43440-1337
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Country | US
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Telephone | 419-798-8203
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Fax | 419-798-4662
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Provider Business Mailing Address
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Address Line | 9400 E NORTHSHORE BLVD
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City | LAKESIDE
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State | OH
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Zip | 43440-1337
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Country | US
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Telephone | 419-798-8203
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Fax | 419-798-4662
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Authorized Official
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Title or Position | TREASURER & CFO
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Name | JAMES CHRIS GREEN
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Credential | CPA
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Telephone | 513-933-5418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NA
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2057N
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License Number State | OH
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