=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841320850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALSHORE HOUSE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2840 W FOSTER AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-561-2040
-----------------------------------------------------
Fax | 773-561-2060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2840 W FOSTER AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-561-2040
-----------------------------------------------------
Fax | 773-561-2060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. PAMELA SOLOMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-561-2040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 0004754
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------