Provider Demographics
NPI:1114744711
Name:ZEBULON HEALTH SOLUTIONS
Entity type:Organization
Organization Name:ZEBULON HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-809-1670
Mailing Address - Street 1:740 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-3019
Mailing Address - Country:US
Mailing Address - Phone:773-809-1670
Mailing Address - Fax:
Practice Address - Street 1:740 E 104TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3019
Practice Address - Country:US
Practice Address - Phone:773-809-1670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty