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General NPI Number Information
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NPI Number | 1427863307
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Entity Type | Organization
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Legal Business Name | HALLOW HEALTH AND PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 305 N VINE ST UNIT 100A
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City | NEW LENOX
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State | IL
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Zip | 60451-1652
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Country | US
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Telephone | 815-435-4055
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Fax |
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Provider Business Mailing Address
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Address Line | 4749 LINCOLN MALL DR STE 202H
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City | MATTESON
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State | IL
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Zip | 60443-3826
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHIBUZO LASISI
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Credential | DNP
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Telephone | 815-435-4055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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