MEDICARE: HONEY POND GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3002775	OTHER	IL	LICENSE NUMBER

General Provider Information

NPI Number	:	1154158269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONEY POND GROUP LLC

Provider Business Mailing Address
First Line	:	4000 W MONTROSE AVE # 2133
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 N MILWAUKEE AVE APT 1504
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-4045
Country	:	US
Telephone Number	:	312-975-0850
Fax Number	:

Authorized Official
Title or Position	:	AGENCY ADMINISTRATOR
Name	:	ADERONKE A. KILASO
Credential	:
Telephone Number	:	312-975-0850

Provider Enumeration Date	:	09/14/2024
Last Update Date	:	09/14/2024

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