Healthcare Provider Details

I. General information

NPI: 1003080870
Provider Name (Legal Business Name): KC HEALTH HORIZONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8964 RAINTREE LN
FRANKFORT IL
60423-6606
US

IV. Provider business mailing address

8964 RAINTREE LN
FRANKFORT IL
60423-6606
US

V. Phone/Fax

Practice location:
  • Phone: 815-806-1966
  • Fax:
Mailing address:
  • Phone: 815-806-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03655042
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. SANDRA CHEATHAM
Title or Position: PRESIDENT
Credential: R.N.
Phone: 815-806-1966