Organization
BELOVED COMMUNITY FAMILY WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IQBAL HUSSAIN (CHIEF FINANCIAL OFFICER)
(773) 651-3635
Entity
Organization
Contact information
Practice address
2338 NEW ST, BLUE ISLAND, IL 60406-2402
(708) 577-5060
(708) 577-5064
Mailing address
6821 S HALSTED ST, CHICAGO, IL 60621-1833
(773) 651-3629
(773) 322-1599
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
BL9194919
IL
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/02/2012
Last updated
03/06/2024
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