Organization
CAMBODIAN ASSOCIATION OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOMPHA SETH (EXECUTIVE DIRECTOR)
(773) 878-7090
Entity
Organization
Contact information
Practice address
123 E LAKE ST STE 204, BLOOMINGDALE, IL 60108-1100
(773) 878-7090
(773) 878-5299
Mailing address
2831 W LAWRENCE AVE, CHICAGO, IL 60625-3619
(773) 878-7090
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
INH1012030
IL
253Z00000X
In Home Supportive Care Agency
INH1402004
IL
253Z00000X
In Home Supportive Care Agency
INH1413006
IL
Other
Enumeration date
05/20/2014
Last updated
05/19/2016
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