Healthcare Provider Details

I. General information

NPI: 1902716822
Provider Name (Legal Business Name): KEVEN HOUSE OF TREASURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 W 107TH ST
CHICAGO IL
60643-3766
US

IV. Provider business mailing address

20133 DRIFTWOOD AVE
LYNWOOD IL
60411-6812
US

V. Phone/Fax

Practice location:
  • Phone: 708-378-0009
  • Fax:
Mailing address:
  • Phone: 708-378-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: AEISHA HOME
Title or Position: COO
Credential: MHA
Phone: 708-378-0009