Provider Demographics
NPI:1427863307
Name:HALLOW HEALTH AND PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:HALLOW HEALTH AND PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIBUZO
Authorized Official - Middle Name:
Authorized Official - Last Name:LASISI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:815-435-4055
Mailing Address - Street 1:4749 LINCOLN MALL DR STE 202H
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 N VINE ST UNIT 100A
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1652
Practice Address - Country:US
Practice Address - Phone:815-435-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty