Provider Demographics
NPI:1114547247
Name:BAAL PERAZIM WELLNESS, INC
Entity Type:Organization
Organization Name:BAAL PERAZIM WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNLEE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FPA
Authorized Official - Phone:773-451-9444
Mailing Address - Street 1:770 N HALSTED ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-7889
Mailing Address - Country:US
Mailing Address - Phone:773-451-9444
Mailing Address - Fax:833-970-1077
Practice Address - Street 1:3353 S MORGAN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6885
Practice Address - Country:US
Practice Address - Phone:773-565-4231
Practice Address - Fax:833-970-1077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAAL PERAZIM WELLNESS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL253231187001Medicaid