Healthcare Provider Details

I. General information

NPI: 1497490155
Provider Name (Legal Business Name): ZION HEALING CENTER SO-CAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S MAGNOLIA AVE STE 203
EL CAJON CA
92020-5224
US

IV. Provider business mailing address

158 N 240 E
HURRICANE UT
84737-1380
US

V. Phone/Fax

Practice location:
  • Phone: 435-319-0351
  • Fax:
Mailing address:
  • Phone: 435-319-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREYDEN JOSEF HEDBERG
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 435-319-0351