Healthcare Provider Details

I. General information

NPI: 1477037802
Provider Name (Legal Business Name): K.A.M ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 W 95TH ST #100
CHICAGO IL
60643-1001
US

IV. Provider business mailing address

2215 W 95TH ST #100
CHICAGO IL
60643-1001
US

V. Phone/Fax

Practice location:
  • Phone: 773-239-9600
  • Fax: 773-239-9601
Mailing address:
  • Phone: 773-239-9600
  • Fax: 773-239-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ANGELA J RATCLIFFE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 773-239-9600