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General NPI Number Information
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NPI Number | 1376138610
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Entity Type | Organization
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Legal Business Name | HEALTHY HEARTS & WELLNESS
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 03/09/2021
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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 | 708-808-0540
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Fax |
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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 | 708-808-0540
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Fax |
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Authorized Official
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Title or Position | NP
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Name | ANGELA BEAL
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Credential | NP
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Telephone | 773-414-7352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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