Provider Demographics
NPI:1881755890
Name:KC CARE INC
Entity type:Organization
Organization Name:KC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN SERVICES DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-363-4000
Mailing Address - Street 1:1525 E 53RD ST
Mailing Address - Street 2:SUITE 932
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4557
Mailing Address - Country:US
Mailing Address - Phone:773-363-4000
Mailing Address - Fax:773-326-0871
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:SUITE 932
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:773-363-4000
Practice Address - Fax:773-326-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490103091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209012Medicare ID - Type UnspecifiedPSYCHOTHERAPY