Healthcare Provider Details

I. General information

NPI: 1356276232
Provider Name (Legal Business Name): ACCESS COMMUNITY WELLNESS ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6758 FIELDSTONE DR
BURR RIDGE IL
60527-5298
US

IV. Provider business mailing address

6758 FIELDSTONE DR
BURR RIDGE IL
60527-5298
US

V. Phone/Fax

Practice location:
  • Phone: 224-715-0739
  • Fax: 224-715-0739
Mailing address:
  • Phone: 224-715-0739
  • Fax: 224-715-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMEERA HUSSAIN
Title or Position: CEO
Credential: HUSSAIN
Phone: 224-715-0739