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General NPI Number Information
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NPI Number | 1699516310
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Entity Type | Organization
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Legal Business Name | KEPT CECRETS LLC
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 934 JUDSON AVE APT 2W
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City | EVANSTON
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State | IL
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Zip | 60202-1864
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Country | US
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Telephone | 773-606-6988
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Fax |
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Provider Business Mailing Address
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Address Line | 934 JUDSON AVE APT 2W
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City | EVANSTON
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State | IL
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Zip | 60202-1864
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Country | US
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Telephone | 773-606-6988
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KENDRA MICHELLE BOYD
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Credential |
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Telephone | 773-606-6988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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