MEDICARE: KIN CARE HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1821731639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIN CARE HOME CARE LLC

Provider Business Mailing Address
First Line	:	39 DOGWOOD ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1811
Country	:	US
Telephone Number	:	708-918-3944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 EMERALD AVE
Second Line	:
City	:	CHICAGO HTS
State	:	IL
Zip	:	60411-3517
Country	:	US
Telephone Number	:	708-918-3944
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANNTRINIA GUNBY
Credential	:
Telephone Number	:	708-918-3944

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	04/19/2022

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