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General NPI Number Information
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NPI Number | 1295195527
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Entity Type | Organization
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Legal Business Name | ZION LW
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 2109 PUTTER PL
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City | KISSIMMEE
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State | FL
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Zip | 34746-3971
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Country | US
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Telephone | 407-435-4791
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 PUTTER PL
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City | KISSIMMEE
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State | FL
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Zip | 34746-3971
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Country | US
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Telephone | 407-435-4791
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Fax | 407-264-8357
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Authorized Official
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Title or Position | CEO
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Name | LIDICE VALENCIA
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Credential | CBHCMS, BA, BS
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Telephone | 407-435-4791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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