1508088030 NPI number — N SHORE SPINAL & SPORTS REHAB LTD

Table of content: (NPI 1508088030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508088030 NPI number — N SHORE SPINAL & SPORTS REHAB LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
N SHORE SPINAL & SPORTS REHAB LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH SHORE CERTIFIED OUTPATIENT REHAB
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508088030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1770 1ST ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60035-3210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-432-4077
Provider Business Mailing Address Fax Number:
847-818-9406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1770 1ST ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60035-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-432-4077
Provider Business Practice Location Address Fax Number:
847-681-8940
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
847-899-1284

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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