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General NPI Number Information
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NPI Number | 1780538652
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Entity Type | Organization
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Legal Business Name | KINSHIP PACE OF ILLINOIS, LLC
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 6560 W FULLERTON AVE STE C144
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City | CHICAGO
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State | IL
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Zip | 60707-3439
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Country | US
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Telephone | 754-328-4715
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Fax |
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Provider Business Mailing Address
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Address Line | 225 CROSSWAYS PARK DR
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City | WOODBURY
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State | NY
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Zip | 11797-2083
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Country | US
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Telephone | 754-328-4715
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | AMBER HULON
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Credential |
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Telephone | 727-417-5819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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