Provider Demographics
NPI:1437864162
Name:HOUSE OF HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:HOUSE OF HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN-FPA, FNP-B
Authorized Official - Phone:773-655-0899
Mailing Address - Street 1:1200 RING RD UNIT 2421
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-7266
Mailing Address - Country:US
Mailing Address - Phone:312-967-5707
Mailing Address - Fax:312-967-9037
Practice Address - Street 1:220 153RD PL
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-4104
Practice Address - Country:US
Practice Address - Phone:312-967-5707
Practice Address - Fax:312-967-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty