Provider Demographics
NPI:1447094602
Name:HEROS HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:HEROS HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POINSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-902-8507
Mailing Address - Street 1:434 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3446
Mailing Address - Country:US
Mailing Address - Phone:773-902-8507
Mailing Address - Fax:
Practice Address - Street 1:C. GUAYACANES 66,
Practice Address - Street 2:
Practice Address - City:COSTAMBAR
Practice Address - State:PUERTO PLATA
Practice Address - Zip Code:57000
Practice Address - Country:DO
Practice Address - Phone:849-636-4065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies