Healthcare Provider Details

I. General information

NPI: 1699549899
Provider Name (Legal Business Name): ZION HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 MILLERS MARK AVE
WAKE FOREST NC
27587-7059
US

IV. Provider business mailing address

669 MILLERS MARK AVE
WAKE FOREST NC
27587-7059
US

V. Phone/Fax

Practice location:
  • Phone: 919-349-2509
  • Fax:
Mailing address:
  • Phone: 919-349-2509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: OLUCHI EZINWA IBEAWUCHI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-349-2509