MEDICARE: GREEN TABLE TALKS NFP

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	174200000X	Meals Provider

General Provider Information

NPI Number	:	1760328199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN TABLE TALKS NFP

Provider Business Mailing Address
First Line	:	3357 S JUSTINE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-7090
Country	:	US
Telephone Number	:	773-979-0199
Fax Number	:

Provider Business Practice Location Address
First Line	:	3357 S JUSTINE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-7090
Country	:	US
Telephone Number	:	773-979-0199
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ENA JONES
Credential	:
Telephone Number	:	773-979-0199

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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