MEDICARE: HEALTHY HEARTS & WELLNESS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251F00000X	Home Infusion Agency
2	261QH0100X	Health Service Clinic/Center
3	261QP2300X	Primary Care Clinic/Center
4	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1174130413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY HEARTS & WELLNESS LLC

Provider Business Mailing Address
First Line	:	2136 W 95TH ST STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1000
Country	:	US
Telephone Number	:	773-840-3922
Fax Number	:	773-409-9381

Provider Business Practice Location Address
First Line	:	2136 W 95TH ST STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1000
Country	:	US
Telephone Number	:	773-840-3922
Fax Number	:	773-409-9381

Authorized Official
Title or Position	:	FNP
Name	:	ANGELA BEAL
Credential	:	NP
Telephone Number	:	708-808-0540

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	09/30/2021

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