Healthcare Provider Details

I. General information

NPI: 1023728292
Provider Name (Legal Business Name): ZA'KIYAH HOUSE HOUSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 KIRKPATRICK AVE
BRADDOCK PA
15104-2512
US

IV. Provider business mailing address

832 KIRKPATRICK AVE
BRADDOCK PA
15104-2512
US

V. Phone/Fax

Practice location:
  • Phone: 412-595-6666
  • Fax:
Mailing address:
  • Phone: 412-595-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
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: MRS. RONNA RENEE DAVIS-MOORE
Title or Position: CEO
Credential: MS
Phone: 412-595-6666