Provider Demographics
NPI:1013088731
Name:KIDNETICS INC.
Entity Type:Organization
Organization Name:KIDNETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-320-2823
Mailing Address - Street 1:1130 N FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2712
Mailing Address - Country:US
Mailing Address - Phone:312-320-2823
Mailing Address - Fax:773-862-0003
Practice Address - Street 1:1130 N FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2712
Practice Address - Country:US
Practice Address - Phone:312-320-2823
Practice Address - Fax:773-862-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1630323OtherBCBS PROVIDER NUMBER