Healthcare Provider Details

I. General information

NPI: 1477372571
Provider Name (Legal Business Name): ZION SELAH HOME HEALTHCARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 S PARKER RD STE 2-1017
AURORA CO
80014-2735
US

IV. Provider business mailing address

2821 S PARKER RD STE 1017
AURORA CO
80014-2714
US

V. Phone/Fax

Practice location:
  • Phone: 616-644-8235
  • Fax:
Mailing address:
  • Phone: 616-644-8235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. WENDEMAGEN THEODORE BENNETT
Title or Position: ADMINISTRATOR AND OWNER
Credential:
Phone: 616-644-8235