Basic Information
| Provider Information | |||||||||
| NPI: | 1821361429 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH SHORE HOME HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 WARRENVILLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302963400 | ||||||||
| FaxNumber: | 6304872713 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 MONTAUK HWY | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117691434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315676555 | ||||||||
| FaxNumber: | 6315677923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2012 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | DARBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP CHIEF STRATEGY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6302963591 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 0318L001 | NY | N | Agencies | Case Management | 253Z00000X | N | Agencies | In Home Supportive Care | 251E00000X | 0318L001 | NY | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 01085496 | 05 | NY | MEDICAID | 01052359 | 05 | NY | MEDICAID |