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General NPI Number Information
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NPI Number | 1861211245
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Entity Type | Organization
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Legal Business Name | KINDRED LIFE MINISTRIES INC
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1319 N HUNT CLUB RD
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City | GURNEE
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State | IL
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Zip | 60031-2442
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Country | US
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Telephone | 847-250-7503
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 853
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City | GRAYSLAKE
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State | IL
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Zip | 60030-0853
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ELIZA LABELLE
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Credential |
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Telephone | 847-250-7503
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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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