Healthcare Provider Details

I. General information

NPI: 1891197620
Provider Name (Legal Business Name): Z LARUE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 COBBS CREEK PKWY
PHILADELPHIA PA
19143-3035
US

IV. Provider business mailing address

5825 COBBS CREEK PKWY
PHILADELPHIA PA
19143-3035
US

V. Phone/Fax

Practice location:
  • Phone: 215-747-5473
  • Fax:
Mailing address:
  • Phone: 215-747-5473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ZINA L SPEIGHT
Title or Position: CEO/DIRECTOR
Credential:
Phone: 215-747-5473