Healthcare Provider Details

I. General information

NPI: 1821731639
Provider Name (Legal Business Name): KIN CARE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 EMERALD AVE
CHICAGO HTS IL
60411-3517
US

IV. Provider business mailing address

39 DOGWOOD ST
PARK FOREST IL
60466-1811
US

V. Phone/Fax

Practice location:
  • Phone: 708-918-3944
  • Fax:
Mailing address:
  • Phone: 708-918-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNTRINIA GUNBY
Title or Position: OWNER
Credential:
Phone: 708-918-3944