Provider Demographics
NPI:1780479246
Name:WILD ZEN LLC
Entity type:Organization
Organization Name:WILD ZEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LABARGE
Authorized Official - Suffix:
Authorized Official - Credentials:DOULA, CBS, LCE, RYT
Authorized Official - Phone:616-648-0444
Mailing Address - Street 1:2379 N BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:CORAL
Mailing Address - State:MI
Mailing Address - Zip Code:49322-9754
Mailing Address - Country:US
Mailing Address - Phone:616-648-0444
Mailing Address - Fax:
Practice Address - Street 1:2379 N BAILEY RD
Practice Address - Street 2:
Practice Address - City:CORAL
Practice Address - State:MI
Practice Address - Zip Code:49322-9754
Practice Address - Country:US
Practice Address - Phone:616-648-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty