MEDICARE: HEALING HANDS RESOURCE CENTER

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)		IL

General Provider Information

NPI Number	:	1912447202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HANDS RESOURCE CENTER

Provider Business Mailing Address
First Line	:	1022 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-4128
Country	:	US
Telephone Number	:	773-814-3202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2128 S CENTRAL PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3113
Country	:	US
Telephone Number	:	773-814-3201
Fax Number	:	773-572-9553

Authorized Official
Title or Position	:	CEO / EXEC DIRECTOR
Name	:	VALENCIA GREEN
Credential	:	MD, MPH
Telephone Number	:	773-467-6967

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	12/19/2023

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