Active NPI
North Shore Healthcare, Inc
- Home Health Agency
- Park Ridge, IL
National Provider Identifier
1215183397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- NORTH SHORE HEALTHCARE, INC
- Practice address
- 1420 Renaissance Dr Ste 312
Park Ridge, IL 60068-1325 - Phone
- (847) 213-0483
- Fax
- (847) 213-0501
- NPI assigned
- Aug 8, 2008
- Last updated
- Jun 27, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ricky Cariaga
- Title
- Administrator
- Phone
- (847) 213-0483
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Primary |
Addresses
Primary practice location
1420 Renaissance Dr Ste 312
Park Ridge, IL 60068-1325
Mailing address
1420 Renaissance Dr Ste 312
Park Ridge, IL 60068-1325
Phone (847) 213-0483
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1011929 | Other | IL | IDPH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111219000934 | IL | Part A Provider - Home Health Agency | 4880869965 | Practice locations: Park Ridge, IL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1215183397. Details of each certification follow.
Home health agency certification: CCN 148326
- Legal name
- NORTH SHORE HEALTHCARE, INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Aug 2, 2012
- Last certification
- Jun 10, 2021
- Ownership / control type
- Proprietary
- Organization structure
- Corporation
- Incorporated
- Jul 17, 2007 in IL
- Enrollment address
- 1420 Renaissance Dr
Ste 312
Park Ridge, IL 60068-1325
Care Compare: Home health agency
Medicare Care Compare- Listed as
- North Shore Healthcare, Inc
- Overall star rating
- Ownership
- Proprietary
- Certified
- Aug 2, 2012
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider Directory- Tax ID family
- North Shore Healthcare Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- Skokie, IL
- NPI 1083020143
Locations
9944 S Roberts Rd
Ste 210
Palos Hills, IL 60465
Phone (708) 658-6545
1420 Renaissance Dr
Ste 312
Park Ridge, IL 60068
Phone (847) 213-0483
Ownership & related parties
All disclosed owners & managing parties 1
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Rizna Mafaz | 5% Or Greater Direct Ownership Interest | Apr 1, 2022 | 100% |
| Corporate Officer | Apr 1, 2022 | 100% | |
| W-2 Managing Employee | Apr 1, 2022 | 100% | |
| Operational/Managerial Control | Apr 1, 2022 | 50% |
Practitioners & affiliated clinicians
Affiliated clinicians 7
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Cardiovascular Disease Physician
- New Lenox, IL
- NPI 1841289691
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218153600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1687824000000",
"number": "1215183397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 RENAISSANCE DR STE 312",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681325",
"telephone_number": "847-213-0483",
"fax_number": "847-213-0501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 RENAISSANCE DR STE 312",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600681325",
"telephone_number": "847-213-0483",
"fax_number": "847-213-0501"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTH SHORE HEALTHCARE, INC",
"organizational_subpart": "NO",
"enumeration_date": "2008-08-08",
"last_updated": "2023-06-27",
"certification_date": "2023-06-27",
"status": "A",
"authorized_official_last_name": "CARIAGA",
"authorized_official_first_name": "RICKY",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "847-213-0483"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDPH",
"identifier": "1011929",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.