- Enrollment id
- O20111219000934
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1215183397
- Multiple npi flag
- N
- Ccn
- 148326
- Associate id
- 4880869965
- Organization name
- NORTH SHORE HEALTHCARE, INC
- Incorporation date
- 2007-07-17
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1420 RENAISSANCE DR
- Address line 2
- STE 312
- City
- PARK RIDGE
- State
- IL
- Zip code
- 600681325