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Organization
CAMBODIAN ASSOCIATION OF ILLINOIS
Active
Organization
CAMBODIAN ASSOCIATION OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KOMPHA SETH (EXECUTIVE DIRECTOR)
(773) 878-7090
Entity
Organization
Contact information
Practice address
2831 W LAWRENCE AVE, CHICAGO, IL 60625-3619
(773) 878-7090
Mailing address
2831 W LAWRENCE AVE, CHICAGO, IL 60625-3619
(773) 878-7090
(773) 878-5299
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
INH1012030
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
INH1012030
—
IL
Enumeration date
06/21/2013
Last updated
08/15/2014
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