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General NPI Number Information
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NPI Number | 1033570114
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Entity Type | Organization
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Legal Business Name | RANDOM ACT OF KINDNESS
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 11346 S PARNELL AVE
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City | CHICAGO
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State | IL
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Zip | 60628-4721
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Country | US
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Telephone | 773-701-6681
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Fax | 773-701-6682
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Provider Business Mailing Address
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Address Line | 11346 S PARNELL AVE
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City | CHICAGO
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State | IL
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Zip | 60628-4721
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Country | US
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Telephone | 773-701-6681
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Fax | 773-701-6682
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. CAMIKO SMITH
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Credential | GENERAL STUDIES
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Telephone | 773-701-6681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 251C00000X
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 347COOOOOX
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 251COOOOX
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License Number State | IL
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