Healthcare Provider Details

I. General information

NPI: 1629522842
Provider Name (Legal Business Name): RANDOM ACT OF KINDNESS DEVELOPMENTAL AGENCY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11346 S PARNELL AVE
CHICAGO IL
60628-4721
US

IV. Provider business mailing address

11346 S PARNELL AVE
CHICAGO IL
60628-4721
US

V. Phone/Fax

Practice location:
  • Phone: 773-701-6681
  • Fax:
Mailing address:
  • Phone: 773-701-6681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. CAMIKO SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: BA
Phone: 773-701-6681