Healthcare Provider Details

I. General information

NPI: 1669032520
Provider Name (Legal Business Name): KC CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E 53RD ST STE 428
CHICAGO IL
60615-4575
US

IV. Provider business mailing address

1525 E 53RD ST STE 428
CHICAGO IL
60615-4575
US

V. Phone/Fax

Practice location:
  • Phone: 312-801-6219
  • Fax: 773-326-0871
Mailing address:
  • Phone: 312-801-6219
  • Fax: 773-326-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KENNETH G WILSON
Title or Position: DIRECTOR
Credential: LCSW
Phone: 312-801-6219