Healthcare Provider Details

I. General information

NPI: 1659830784
Provider Name (Legal Business Name): HOME CARE KINECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 S DELANO CT W STE B201
CHICAGO IL
60605-3734
US

IV. Provider business mailing address

3560 S GILES AVE UNIT 3
CHICAGO IL
60653-1159
US

V. Phone/Fax

Practice location:
  • Phone: 312-528-3200
  • Fax:
Mailing address:
  • Phone: 708-704-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY MARTINEZ WHITE
Title or Position: AGENCY MANAGER
Credential:
Phone: 708-704-2851