Healthcare Provider Details

I. General information

NPI: 1548426463
Provider Name (Legal Business Name): ZION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 STEWART AVE
SAINT PAUL MN
55116-3036
US

IV. Provider business mailing address

2403 STEWART AVE
SAINT PAUL MN
55116-3036
US

V. Phone/Fax

Practice location:
  • Phone: 612-481-6001
  • Fax: 651-698-9466
Mailing address:
  • Phone: 612-481-6005
  • Fax: 651-698-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR183439-8
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberL061734-1
License Number StateMN

VIII. Authorized Official

Name: MR. VALLANTINE EBOT ATEM
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-481-6005