Healthcare Provider Details

I. General information

NPI: 1053540542
Provider Name (Legal Business Name): K. CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9003 PARKSIDE AVE
OAK LAWN IL
60453-1628
US

IV. Provider business mailing address

9003 PARKSIDE AVE
OAK LAWN IL
60453-1628
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-2845
  • Fax: 708-229-2845
Mailing address:
  • Phone: 708-229-2845
  • Fax: 708-229-2845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number40429A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number124583576739574124
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number40429A
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number40429A
License Number StateIL

VIII. Authorized Official

Name: MR. KWABENA APPIAH
Title or Position: MANAGER
Credential:
Phone: 708-229-2845