Provider Demographics
NPI:1700594009
Name:KODO CARE, INC.
Entity Type:Organization
Organization Name:KODO CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:815-727-4722
Mailing Address - Street 1:2401 W JEFFERSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-7830
Mailing Address - Country:US
Mailing Address - Phone:815-727-4722
Mailing Address - Fax:815-727-4731
Practice Address - Street 1:2401 W JEFFERSON ST STE 100
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-7830
Practice Address - Country:US
Practice Address - Phone:815-727-4722
Practice Address - Fax:815-727-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy