Healthcare Provider Details

I. General information

NPI: 1366274805
Provider Name (Legal Business Name): ZOE COFFEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 WOODLAND ST NE
WARREN OH
44483-5348
US

IV. Provider business mailing address

1705 WOODLAND ST NE
WARREN OH
44483-5348
US

V. Phone/Fax

Practice location:
  • Phone: 330-469-6777
  • Fax:
Mailing address:
  • Phone: 330-469-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2403636-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: