Organization
SOUTH SHORE HOSPITAL CORPORATION
Active
Other names
South Shore Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LESLIE M. ROGERS CHE (ADMINISTRATOR)
(773) 356-5200
Entity
Organization
Contact information
Practice address
8012 S CRANDON AVE, CHICAGO, IL 60617-1124
(773) 356-5200
(773) 768-8154
Mailing address
8012 S CRANDON AVE, CHICAGO, IL 60617-1124
(773) 356-5200
(773) 768-8154
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
164.004009
IL
163W00000X
Registered Nurse
Primary
041.147476
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214641
AMERICAN ASSOCIATION OF DIABETES EDUCATORS
IL
05
—
51204952001
—
IL
Enumeration date
07/16/2013
Last updated
12/31/2013
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