Provider Demographics
NPI:1144731944
Name:HOPE WELLNESS CENTER AND SPA PC
Entity type:Organization
Organization Name:HOPE WELLNESS CENTER AND SPA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON-WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:773-985-5734
Mailing Address - Street 1:10540 S WESTERN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2541
Mailing Address - Country:US
Mailing Address - Phone:773-985-5734
Mailing Address - Fax:773-941-5131
Practice Address - Street 1:10540 S WESTERN AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2541
Practice Address - Country:US
Practice Address - Phone:773-985-5734
Practice Address - Fax:773-941-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
IL209010507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty