Provider Demographics
NPI:1699516310
Name:KEPT CECRETS LLC
Entity type:Organization
Organization Name:KEPT CECRETS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-606-6988
Mailing Address - Street 1:934 JUDSON AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1864
Mailing Address - Country:US
Mailing Address - Phone:773-606-6988
Mailing Address - Fax:
Practice Address - Street 1:934 JUDSON AVE APT 2W
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1864
Practice Address - Country:US
Practice Address - Phone:773-606-6988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle