MEDICARE: ZEEDUB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	APPLICATION PENDING	IN

General Provider Information

NPI Number	:	1144534793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZEEDUB LLC

Provider Business Mailing Address
First Line	:	4807 ILLINOIS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1165
Country	:	US
Telephone Number	:	260-918-0933
Fax Number	:	260-918-0931

Provider Business Practice Location Address
First Line	:	4807 ILLINOIS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1165
Country	:	US
Telephone Number	:	260-918-0933
Fax Number	:	260-918-0931

Authorized Official
Title or Position	:	CEO
Name	:	MR. STEVE FREDRICK ZISHKA
Credential	:
Telephone Number	:	260-918-0933

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	08/05/2010

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