Healthcare Provider Details

I. General information

NPI: 1245367994
Provider Name (Legal Business Name): KND HEALTH CARE SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 B S MAIN SRTEET
SENECA IL
61360-0440
US

IV. Provider business mailing address

260 B S MAIN STREET
SENECA IL
61360-0440
US

V. Phone/Fax

Practice location:
  • Phone: 815-357-9898
  • Fax: 815-357-6528
Mailing address:
  • Phone: 815-357-9898
  • Fax: 815-357-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. DEEPAK T DATTANI
Title or Position: PHARMACY MANAGER
Credential: R. PH
Phone: 815-357-9898