MEDICARE: BAAL PERAZIM WELLNESS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114547247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAAL PERAZIM WELLNESS, INC

Provider Business Mailing Address
First Line	:	770 N HALSTED ST STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-7889
Country	:	US
Telephone Number	:	773-451-9444
Fax Number	:	833-970-1077

Provider Business Practice Location Address
First Line	:	3353 S MORGAN ST UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-6885
Country	:	US
Telephone Number	:	773-565-4231
Fax Number	:	833-970-1077

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. MAURICE BROWNLEE
Credential	:	APRN-FPA
Telephone Number	:	773-451-9444

Provider Enumeration Date	:	04/18/2020
Last Update Date	:	04/18/2020

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Directions to “BAAL PERAZIM WELLNESS, INC ” Practice Location

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