| Uic-mshc Hope Academy Health And Wellness Ctr | |
|
1628 W Washington Blvd Chicago IL 60612-2613 | |
| (312) 226-3288 | |
| (312) 226-3541 |
| Full Name | Uic-mshc Hope Academy Health And Wellness Ctr |
|---|---|
| Speciality | Clinic/Center |
| Location | 1628 W Washington Blvd, Chicago, Illinois |
| Authorized Official Name and Position | Henry Taylor (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3124131261 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Uic-mshc Hope Academy Health And Wellness Ctr 2045 W Washington Blvd Chicago IL 60612-2428 Ph: (312) 413-9854 | Uic-mshc Hope Academy Health And Wellness Ctr 1628 W Washington Blvd Chicago IL 60612-2613 Ph: (312) 226-3288 |
| NPI Number | 1043510241 |
|---|---|
| Provider Enumeration Date | 10/22/2010 |
| Last Update Date | 12/10/2015 |
| Medicare PECOS PAC ID | 3072422716 |
|---|---|
| Medicare Enrollment ID | O20151103002344 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043510241 | NPI | - | NPPES |
| 1622185 | Other | IL | BCBC PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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