1154158269 NPI number — HONEY POND GROUP LLC

Table of content: (NPI 1154158269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154158269 NPI number — HONEY POND GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HONEY POND GROUP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154158269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 W MONTROSE AVE # 2133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60641-2140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1165 N MILWAUKEE AVE APT 1504
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60642-4045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-975-0850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2024

Additional Information

Authorized Official

Authorized Official Last Name:
KILASO
Authorized Official First Name:
ADERONKE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
AGENCY ADMINISTRATOR
Authorized Official Telephone Number:
312-975-0850

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3002775 . This is a "LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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