=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629854062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZOA HEALTHCARE SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2023
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3405 DULUTH PARK LN # A
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30096-3287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-819-7055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3405 DULUTH PARK LN # A
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30096-3287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-819-7055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. SUNHEE KIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-819-7055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------