Healthcare Provider Details

I. General information

NPI: 1922514793
Provider Name (Legal Business Name): ZION COMPASSION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8257 E GUADALUPE RD STE 117
MESA AZ
85212-9636
US

IV. Provider business mailing address

3560 W MESQUITE AVE
QUEEN CREEK AZ
85142-6597
US

V. Phone/Fax

Practice location:
  • Phone: 480-233-2099
  • Fax: 480-245-1050
Mailing address:
  • Phone: 480-233-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier660047
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerAHCCCS

VIII. Authorized Official

Name: ENOCK ASAMOAH GYAU
Title or Position: CEO
Credential:
Phone: 480-233-2099