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General NPI Number Information
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NPI Number | 1023351996
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Entity Type | Organization
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Legal Business Name | ZION'S ASSISTED LIVING FACILITY, INC.
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 2029 JUPITER BLVD SW
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City | PALM BAY
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State | FL
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Zip | 32908
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Country | US
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Telephone | 321-727-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 2029 JUPITER BLVD SW
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City | PALM BAY
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State | FL
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Zip | 32908-3330
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Country | US
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Telephone | 321-727-8811
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHERON PATRICIA WHYNE
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Credential |
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Telephone | 321-727-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11719
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License Number State | FL
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