Healthcare Provider Details

I. General information

NPI: 1528408648
Provider Name (Legal Business Name): ZABRINAS JOLLY BUNCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6134 WISTERIA HL
SAN ANTONIO TX
78218-3108
US

IV. Provider business mailing address

6134 WISTERIA HL
SAN ANTONIO TX
78218-3108
US

V. Phone/Fax

Practice location:
  • Phone: 210-279-7839
  • Fax:
Mailing address:
  • Phone: 210-279-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZABRINA C GIBSON OHANWE
Title or Position: DIRECTOR
Credential:
Phone: 210-279-7839