Healthcare Provider Details

I. General information

NPI: 1023546819
Provider Name (Legal Business Name): ZION LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 E WOOD ST
PHOENIX AZ
85040-1360
US

IV. Provider business mailing address

1618 E WOOD ST
PHOENIX AZ
85040-1360
US

V. Phone/Fax

Practice location:
  • Phone: 602-904-2439
  • Fax:
Mailing address:
  • Phone: 602-904-2439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH5142
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberBH5142
License Number StateAZ

VIII. Authorized Official

Name: MS. SHAWN PEARSON
Title or Position: CEO
Credential: MA
Phone: 602-904-2439