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General NPI Number Information
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NPI Number | 1568693778
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Entity Type | Organization
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Legal Business Name | ZENITH PROVIDERS
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 3802 BROADACRES DR
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City | GREENSBORO
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State | NC
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Zip | 27407-6502
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Country | US
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Telephone | 336-471-7663
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Fax | 336-886-7637
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Provider Business Mailing Address
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Address Line | 3802 BROADACRES DR
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City | GREENSBORO
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State | NC
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Zip | 27407-6502
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Country | US
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Telephone | 336-855-7936
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Fax | 336-855-7936
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. VICKIE LIGHTNER HENRY
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Credential |
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Telephone | 336-707-4636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-041-920
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License Number State | NC
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