Healthcare Provider Details

I. General information

NPI: 1023884301
Provider Name (Legal Business Name): ZOELIFE WELL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 SHEPHERD ST NW
WASHINGTON DC
20011-5944
US

IV. Provider business mailing address

236 LUNAYENA RD
RHOME TX
76078-5282
US

V. Phone/Fax

Practice location:
  • Phone: 682-593-9295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JONICA BADAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 682-593-9295