Organization
KWANZA SUITES CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL K ADDISON (EXECUTIVE DIRECTOR)
(773) 814-1123
Entity
Organization
Contact information
Practice address
9652 S FRANCISCO AVE, EVERGREEN PARK, IL 60805-2710
(708) 425-0193
Mailing address
9652 S FRANCISCO AVE, EVERGREEN PARK, IL 60805-2710
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/01/2016
Last updated
07/01/2016
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