| Glc Wellness Center Illinois Llc | |
|
7118 S Jeffery Blvd Chicago IL 60649-2426 | |
| (877) 767-1692 | |
| Not Available |
| Full Name | Glc Wellness Center Illinois Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7118 S Jeffery Blvd, Chicago, Illinois |
| Authorized Official Name and Position | Nancy Griffin (OWNER-CEO) |
| Authorized Official Contact | 3129990808 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glc Wellness Center Illinois Llc Po Box 3543 Oak Brook IL 60522-3543 Ph: (312) 730-4355 | Glc Wellness Center Illinois Llc 7118 S Jeffery Blvd Chicago IL 60649-2426 Ph: (877) 767-1692 |
| NPI Number | 1508414723 |
|---|---|
| Provider Enumeration Date | 08/30/2019 |
| Last Update Date | 08/31/2021 |
| Certification Date | 08/31/2021 |
| Medicare PECOS PAC ID | 6305269903 |
|---|---|
| Medicare Enrollment ID | O20200714002787 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508414723 | NPI | - | NPPES |
| Provider Name | Joyce R Weston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700211034 PECOS PAC ID: 4688809171 Enrollment ID: I20131111000137 |
| Provider Name | Laura E Minarich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063884344 PECOS PAC ID: 7315247350 Enrollment ID: I20151124001677 |
| Provider Name | Lanesia Cephus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598120719 PECOS PAC ID: 8426357591 Enrollment ID: I20160425001930 |
| Provider Name | Ngozika Adindu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659862266 PECOS PAC ID: 9335492933 Enrollment ID: I20181029002931 |
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