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General NPI Number Information
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NPI Number | 1174130413
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Entity Type | Organization
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Legal Business Name | HEALTHY HEARTS & WELLNESS LLC
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 2136 W 95TH ST STE 201
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City | CHICAGO
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State | IL
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Zip | 60643-1000
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Country | US
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Telephone | 773-840-3922
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Fax | 773-409-9381
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Provider Business Mailing Address
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Address Line | 2136 W 95TH ST STE 201
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City | CHICAGO
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State | IL
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Zip | 60643-1000
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Country | US
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Telephone | 773-840-3922
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Fax | 773-409-9381
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Authorized Official
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Title or Position | FNP
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Name | ANGELA BEAL
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Credential | NP
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Telephone | 708-808-0540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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