Provider Demographics
NPI:1912534975
Name:HEALING HANDS RESOURCE CENTER OAK LAWN
Entity Type:Organization
Organization Name:HEALING HANDS RESOURCE CENTER OAK LAWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-467-6967
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:773-467-6967
Mailing Address - Fax:773-572-9553
Practice Address - Street 1:4550 W 103RD ST STE 302
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4868
Practice Address - Country:US
Practice Address - Phone:773-467-6967
Practice Address - Fax:773-572-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty