Healthcare Provider Details

I. General information

NPI: 1760328199
Provider Name (Legal Business Name): GREEN TABLE TALKS NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3357 S JUSTINE ST
CHICAGO IL
60608-7090
US

IV. Provider business mailing address

3357 S JUSTINE ST
CHICAGO IL
60608-7090
US

V. Phone/Fax

Practice location:
  • Phone: 773-979-0199
  • Fax:
Mailing address:
  • Phone: 773-979-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: ENA JONES
Title or Position: DIRECTOR
Credential:
Phone: 773-979-0199