Healthcare Provider Details

I. General information

NPI: 1497476683
Provider Name (Legal Business Name): HOPE DIAGNOSTIC AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S 5TH AVE
MAYWOOD IL
60153-2128
US

IV. Provider business mailing address

1415 S 5TH AVE
MAYWOOD IL
60153-2128
US

V. Phone/Fax

Practice location:
  • Phone: 708-529-7537
  • Fax: 708-529-7230
Mailing address:
  • Phone: 708-529-7537
  • Fax: 708-529-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MOSES O. ADEYANJU
Title or Position: OWNER
Credential: MD
Phone: 708-529-7537