Healthcare Provider Details

I. General information

NPI: 1396278883
Provider Name (Legal Business Name): OCIE BOOKER HEALTH AND WELLNESS CENTER OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10558 S MICHIGAN AVE
CHICAGO IL
60628-2706
US

IV. Provider business mailing address

1163 E 159TH PL
SOUTH HOLLAND IL
60473-1711
US

V. Phone/Fax

Practice location:
  • Phone: 773-704-2370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY HODGES
Title or Position: EXECUTIVE BOARD MEMBER
Credential:
Phone: 773-704-2370