| Beloved Community Family Wellness Center | |
|
6821 S Halsted St Chicago IL 60621-1833 | |
| (773) 651-3629 | |
| (773) 651-1599 |
| Full Name | Beloved Community Family Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 6821 S Halsted St, Chicago, Illinois |
| Authorized Official Name and Position | Margie Neda Johnson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7736513828 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beloved Community Family Wellness Center 6821 S Halsted St Chicago IL 60621-1833 Ph: (773) 651-3629 | Beloved Community Family Wellness Center 6821 S Halsted St Chicago IL 60621-1833 Ph: (773) 651-3629 |
| NPI Number | 1144528167 |
|---|---|
| Provider Enumeration Date | 03/01/2011 |
| Last Update Date | 08/24/2017 |
| Medicare PECOS PAC ID | 0042216038 |
|---|---|
| Medicare Enrollment ID | O20101116000006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144528167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 036113305 (Illinois) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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