=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871651588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH SHORE HOME HEALTH SERVICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3275 VETERANS HWY STE B15
-----------------------------------------------------
City | RONKONKOMA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11779-7665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-567-6555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 WARRENVILLE RD STE 800
-----------------------------------------------------
City | LISLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60532-0912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-296-3400
-----------------------------------------------------
Fax | 630-487-2713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP CHIEF STRATEGY OFFICER
-----------------------------------------------------
Name | DARBY ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-296-3443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 0318L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------