Healthcare Provider Details

I. General information

NPI: 1952768970
Provider Name (Legal Business Name): ZAKIYA LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 E OUTER DR
DETROIT MI
48224-2487
US

IV. Provider business mailing address

PO BOX 181
ROSEVILLE MI
48066-0181
US

V. Phone/Fax

Practice location:
  • Phone: 313-338-8999
  • Fax:
Mailing address:
  • Phone:
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. ZIPPORAH K BOLAR SR.
Title or Position: OWNER
Credential:
Phone: 313-338-8999