Provider Demographics
NPI:1083267587
Name:KAYSANGELCARE
Entity Type:Organization
Organization Name:KAYSANGELCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOJISOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAYODE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:773-495-6952
Mailing Address - Street 1:2054 W CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2608
Mailing Address - Country:US
Mailing Address - Phone:773-495-6952
Mailing Address - Fax:847-868-8464
Practice Address - Street 1:1325 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3766
Practice Address - Country:US
Practice Address - Phone:773-495-6952
Practice Address - Fax:847-868-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service