Provider Demographics
NPI:1528143088
Name:KINDRED THC NORTH SHORE, LLC
Entity type:Organization
Organization Name:KINDRED THC NORTH SHORE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:6130 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2830
Mailing Address - Country:US
Mailing Address - Phone:773-381-1222
Mailing Address - Fax:773-381-0280
Practice Address - Street 1:6130 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660
Practice Address - Country:US
Practice Address - Phone:773-381-1222
Practice Address - Fax:773-381-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000014282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID195OtherBLUE CROSS
IL363915965OtherUNICARE
IL363915965007Medicaid
ID195OtherBLUE CROSS
IL=========OtherAETNA
ID=========OtherUNITED HEALTHCARE
IL=========OtherHUMANA
ID195OtherBLUE CROSS