=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306404884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZION HEALTH HOMES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2019
-----------------------------------------------------
Last Update Date | 05/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19665 E CARRIAGE WAY
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-8673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-248-6406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19665 E CARRIAGE WAY
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-8673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-248-6406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR /CEO
-----------------------------------------------------
Name | SAMUEL NJOROGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-248-6406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------