Healthcare Provider Details

I. General information

NPI: 1740993732
Provider Name (Legal Business Name): ZION HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 16TH AVE S APT 308
FARGO ND
58103-8946
US

IV. Provider business mailing address

4902 16TH AVE S APT 308
FARGO ND
58103-8946
US

V. Phone/Fax

Practice location:
  • Phone: 701-793-3297
  • Fax:
Mailing address:
  • Phone: 701-793-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAMESETTA KAIDDY MILLER
Title or Position: MANAGER
Credential:
Phone: 701-793-3297