Healthcare Provider Details

I. General information

NPI: 1669247524
Provider Name (Legal Business Name): COMMUNITY WELLNESS AND HEALTH CENTER NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DON CARLOS DR
HANOVER PARK IL
60133-6703
US

IV. Provider business mailing address

12 DON CARLOS DR
HANOVER PARK IL
60133-6703
US

V. Phone/Fax

Practice location:
  • Phone: 773-754-7595
  • Fax:
Mailing address:
  • Phone: 773-754-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NAUMAN KHAN AZEEMI
Title or Position: PRESIDENT
Credential:
Phone: 773-754-7595