Provider Demographics
NPI:1740673599
Name:AMCCAIN LLC
Entity type:Organization
Organization Name:AMCCAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:219-805-4947
Mailing Address - Street 1:1507 E 53RD ST
Mailing Address - Street 2:#932
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4573
Mailing Address - Country:US
Mailing Address - Phone:219-805-4947
Mailing Address - Fax:
Practice Address - Street 1:1507 E 53RD ST
Practice Address - Street 2:#932
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4573
Practice Address - Country:US
Practice Address - Phone:219-805-4947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006026251C00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency