=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164398244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZIALTY BUSINESS SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2025
-----------------------------------------------------
Last Update Date | 10/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10384 DAVIS RD
-----------------------------------------------------
City | GLEN SAINT MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32040-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-408-1802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10384 DAVIS RD
-----------------------------------------------------
City | GLEN SAINT MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32040-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-408-1802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | CARLIYA JEFFERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-408-1802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------