MEDICARE: KINDRED THC NORTH SHORE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282E00000X	Long Term Care Hospital

General Provider Information

NPI Number	:	1700492014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDRED THC NORTH SHORE, LLC

Provider Business Mailing Address
First Line	:	4058 W MELROSE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4799
Country	:	US
Telephone Number	:	773-736-7000
Fax Number	:	773-202-4355

Provider Business Practice Location Address
First Line	:	4058 W MELROSE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4799
Country	:	US
Telephone Number	:	773-736-7000
Fax Number	:	773-202-4355

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	TERRANCE K DILLON
Credential	:
Telephone Number	:	502-596-7220

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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