Provider Demographics
NPI:1902130339
Name:AURORA CHICAGO LAKESHORE HOSPITAL LLC
Entity Type:Organization
Organization Name:AURORA CHICAGO LAKESHORE HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:REMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-433-0057
Mailing Address - Street 1:4840 N MARINE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7860
Mailing Address - Country:US
Mailing Address - Phone:773-878-9700
Mailing Address - Fax:
Practice Address - Street 1:4840 N MARINE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7860
Practice Address - Country:US
Practice Address - Phone:773-878-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361090242084P0804X
IL0361134002084P0804X
IL0361116152084P0804X
IL0361183792084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty