Organization
SOUTH SHORE HOSPITAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY A. CAVENEY (CHIEF FINANCIAL OFFICER)
(773) 356-5312
Entity
Organization
Contact information
Practice address
8012 S CRANDON AVE, CHICAGO, IL 60617-1124
(773) 356-5312
(773) 768-8154
Mailing address
8012 S CRANDON AVE, CHICAGO, IL 60617-1124
(773) 356-5312
(773) 768-8154
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
1706462
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
510204952401
—
IL
Enumeration date
11/29/2006
Last updated
08/22/2020
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