Provider Demographics
NPI:1386153583
Name:SENIOR HEALTH INFORMATION NETWORK
Entity type:Organization
Organization Name:SENIOR HEALTH INFORMATION NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-306-4843
Mailing Address - Street 1:5757 N LINCOLN AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4729
Mailing Address - Country:US
Mailing Address - Phone:877-981-6500
Mailing Address - Fax:
Practice Address - Street 1:5757 N LINCOLN AVE STE 15
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4729
Practice Address - Country:US
Practice Address - Phone:612-306-4843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251G00000X, 251J00000X, 251S00000X, 253Z00000X, 275N00000X, 302F00000X
IL252Y00000X, 282J00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility