Provider Demographics
NPI:1629522842
Name:RANDOM ACT OF KINDNESS DEVELOPMENTAL AGENCY INC.
Entity Type:Organization
Organization Name:RANDOM ACT OF KINDNESS DEVELOPMENTAL AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:773-701-6681
Mailing Address - Street 1:11346 S PARNELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4721
Mailing Address - Country:US
Mailing Address - Phone:773-701-6681
Mailing Address - Fax:
Practice Address - Street 1:11346 S PARNELL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4721
Practice Address - Country:US
Practice Address - Phone:773-701-6681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251300000XAgenciesLocal Education Agency (LEA)