Organization
SHORE COMMUNITY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD GULLEY (EXECUTIVE DIRECTOR)
(847) 982-2030
Entity
Organization
Contact information
Practice address
4232 DEMPSTER ST, SKOKIE, IL 60076
(847) 982-2030
(847) 982-2039
Mailing address
4232 DEMPSTER ST, SKOKIE, IL 60076
(847) 982-2030
(847) 982-2039
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14G084
—
IL
Enumeration date
02/15/2007
Last updated
09/11/2025
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