Healthcare Provider Details

I. General information

NPI: 1255630356
Provider Name (Legal Business Name): DAUGHTERS OF ZION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8444 BANDIT BLUFF AVE
LAS VEGAS NV
89143-0289
US

IV. Provider business mailing address

3008 SANDBAR CT
LAS VEGAS NV
89117-0289
US

V. Phone/Fax

Practice location:
  • Phone: 702-327-2143
  • Fax: 702-635-5463
Mailing address:
  • Phone: 702-327-2143
  • Fax: 702-635-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. PAIGE WINETTE SIGGAL
Title or Position: GROUP HOME ADMISNITRATOR
Credential:
Phone: 702-327-2143