MEDICARE: ZINNIA PERSONAL HOME CARE, INC.

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	251J00000X	Nursing Care Agency
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1790114528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZINNIA PERSONAL HOME CARE, INC.

Provider Business Mailing Address
First Line	:	1323 MONTANA AVE.
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-5441
Country	:	US
Telephone Number	:	915-307-5335
Fax Number	:	915-307-5339

Provider Business Practice Location Address
First Line	:	1323 MONTANA AVE.
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-5441
Country	:	US
Telephone Number	:	915-307-5335
Fax Number	:	915-307-5339

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. VIRGINIA GONZALEZ
Credential	:
Telephone Number	:	915-541-0033

Provider Enumeration Date	:	11/02/2013
Last Update Date	:	10/05/2018

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