Provider Demographics
NPI:1669069100
Name:L.K.C. HEALTH AND WELLNESS
Entity type:Organization
Organization Name:L.K.C. HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:312-203-6979
Mailing Address - Street 1:19830 LAKE LYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19830 LAKE LYNWOOD DR
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60411-1472
Practice Address - Country:US
Practice Address - Phone:312-203-6979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:L.K.C. SPA SPECTACULAR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty