Provider Demographics
NPI:1528528106
Name:SHORELINE MEDICAL EQUIPMENT,LLC
Entity type:Organization
Organization Name:SHORELINE MEDICAL EQUIPMENT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-886-1533
Mailing Address - Street 1:320 S. CALIFORNIA AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3693
Mailing Address - Country:US
Mailing Address - Phone:773-886-1533
Mailing Address - Fax:773-886-1642
Practice Address - Street 1:320 S. CALIFORNIA AVE
Practice Address - Street 2:STE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:773-886-1533
Practice Address - Fax:773-886-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies