Provider Demographics
NPI:1154158269
Name:HONEY POND GROUP LLC
Entity type:Organization
Organization Name:HONEY POND GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADERONKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KILASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-975-0850
Mailing Address - Street 1:4000 W MONTROSE AVE # 2133
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1165 N MILWAUKEE AVE APT 1504
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4045
Practice Address - Country:US
Practice Address - Phone:312-975-0850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3002775OtherLICENSE NUMBER