Provider Demographics
NPI:1881486637
Name:SHORE LIGHT BEHAVIORAL HEALTH OF ILLINOIS LLC
Entity type:Organization
Organization Name:SHORE LIGHT BEHAVIORAL HEALTH OF ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:VANHOOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-750-2014
Mailing Address - Street 1:2955 E 1ST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6775 PROSPERI DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4789
Practice Address - Country:US
Practice Address - Phone:888-486-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital