Organization
KTK AMAZING GRACE HOME HEALTH CARE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADESOLA SODIPE (ADMINISTRATOR)
(815) 557-7277
Entity
Organization
Contact information
Practice address
1 DEARBORN SQ, SUITE 444, KANKAKEE, IL 60901-3942
(815) 557-7277
Mailing address
1 DEARBORN SQ, SUITE 444, KANKAKEE, IL 60901-3942
(815) 557-7277
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1011808
STATE LICENSE
IL
Enumeration date
03/13/2016
Last updated
03/13/2016
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