Individual
CHARLES KINNEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
112 W PARK ST APT 1E, ELWOOD, IL 60421-9628
(815) 540-2875
Mailing address
3 DAVISON ST APT 2, JOLIET, IL 60433-1369
(815) 540-2875
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
—
—
311ZA0620X
Adult Care Home Facility
—
IL
372500000X
Chore Provider
Primary
—
IL
Other
Enumeration date
03/18/2025
Last updated
03/18/2025
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