MEDICARE: DAUGHTERS OF ZION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1255630356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAUGHTERS OF ZION LLC

Provider Business Mailing Address
First Line	:	3008 SANDBAR CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-0289
Country	:	US
Telephone Number	:	702-327-2143
Fax Number	:	702-635-5463

Provider Business Practice Location Address
First Line	:	8444 BANDIT BLUFF AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-0289
Country	:	US
Telephone Number	:	702-327-2143
Fax Number	:	702-635-5463

Authorized Official
Title or Position	:	GROUP HOME ADMISNITRATOR
Name	:	MS. PAIGE WINETTE SIGGAL
Credential	:
Telephone Number	:	702-327-2143

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	04/28/2011

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Directions to “DAUGHTERS OF ZION LLC ” Practice Location

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