Healthcare Provider Details

I. General information

NPI: 1689500399
Provider Name (Legal Business Name): KLC INDEPENDENT LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W GARFIELD BLVD
CHICAGO IL
60636-1210
US

IV. Provider business mailing address

1717 W GARFIELD BLVD
CHICAGO IL
60636-1210
US

V. Phone/Fax

Practice location:
  • Phone: 773-396-8610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: KANDACE CURTISS
Title or Position: DIRECTOR
Credential: DR
Phone: 773-396-8610