MEDICARE: ZACK GROUP, INC.

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

General Provider Information

NPI Number	:	1255561940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZACK GROUP, INC.

Provider Business Mailing Address
First Line	:	6335 W 110TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1509
Country	:	US
Telephone Number	:	913-491-3562
Fax Number	:	913-491-3563

Provider Business Practice Location Address
First Line	:	6335 W 110TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1509
Country	:	US
Telephone Number	:	913-491-3562
Fax Number	:	913-491-3563

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD ZACK
Credential	:
Telephone Number	:	913-491-3662

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	03/07/2011

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