Organization
SOUTH SHORE HOSPITAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY ARTHUR CAVENEY (CHIEF FINANCIAL OFFICER)
(773) 356-5312
Entity
Organization
Contact information
Practice address
8012 S CRANDON AVE, CHICAGO, IL 60617-1124
(773) 356-5000
(773) 768-8154
Mailing address
8012 S CRANDON AVE, CHICAGO, IL 60617-1124
(773) 356-5000
(773) 768-8154
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
2065105
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
510204952001
—
IL
05
—
510204952401
—
IL
Enumeration date
05/30/2012
Last updated
08/15/2012
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