Provider Demographics
NPI:1750822763
Name:HEALING HANDS RESOURCE CENTER STREATOR
Entity Type:Organization
Organization Name:HEALING HANDS RESOURCE CENTER STREATOR
Other - Org Name:HEALING HANDS RESOURCE CENTER STREATOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YIHOODAH
Authorized Official - Middle Name:YISRAEL
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-814-3202
Mailing Address - Street 1:1022 N KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-4128
Mailing Address - Country:US
Mailing Address - Phone:773-814-3202
Mailing Address - Fax:773-572-9553
Practice Address - Street 1:401 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2705
Practice Address - Country:US
Practice Address - Phone:773-814-3202
Practice Address - Fax:773-572-9553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALING HANDS RESOURCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty