=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811394158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZAYAN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2014
-----------------------------------------------------
Last Update Date | 05/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 RENAISSANCE DR STE 211
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-1342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-380-7644
-----------------------------------------------------
Fax | 844-549-2273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1420 RENAISSANCE DR STE 211
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-1342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-380-7644
-----------------------------------------------------
Fax | 844-549-2273
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SHAFIA A KHATOON
-----------------------------------------------------
Credential | RDH
-----------------------------------------------------
Telephone | 847-380-7644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 3001142
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------