| Beloved Community Family Wellness Center | |
|
2338 New St Blue Island IL 60406-2402 | |
| (708) 577-5060 | |
| (708) 577-5064 |
| Full Name | Beloved Community Family Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2338 New St, Blue Island, Illinois |
| Authorized Official Name and Position | Iqbal Hussain (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7736513635 |
| 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 2338 New St Blue Island IL 60406-2402 Ph: (708) 577-5060 |
| NPI Number | 1114278009 |
|---|---|
| Provider Enumeration Date | 10/02/2012 |
| Last Update Date | 03/06/2024 |
| Medicare PECOS PAC ID | 0042216038 |
|---|---|
| Medicare Enrollment ID | O20130118000418 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114278009 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | BL9194919 (Illinois) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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