Provider Demographics
NPI:1568599116
Name:KND HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:KND HEALTH CARE SERVICES
Other - Org Name:SENECA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:T
Authorized Official - Last Name:DATTANI
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:815-357-6464
Mailing Address - Street 1:260 A SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:IL
Mailing Address - Zip Code:61360-0440
Mailing Address - Country:US
Mailing Address - Phone:815-357-6464
Mailing Address - Fax:815-357-6475
Practice Address - Street 1:260 A SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:IL
Practice Address - Zip Code:61360-0440
Practice Address - Country:US
Practice Address - Phone:815-357-6464
Practice Address - Fax:815-357-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL053.0134393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL1074760001Medicare ID - Type Unspecified