Provider Demographics
NPI:1225622939
Name:K.A.M ALLIANCE, INC.
Entity Type:Organization
Organization Name:K.A.M ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RATCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-239-9600
Mailing Address - Street 1:2215 W 95TH ST # 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1001
Mailing Address - Country:US
Mailing Address - Phone:773-239-9600
Mailing Address - Fax:773-239-9601
Practice Address - Street 1:2215 W 95TH ST # 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1001
Practice Address - Country:US
Practice Address - Phone:773-239-9600
Practice Address - Fax:773-239-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-6958-0001-AMedicaid