MEDICARE: LIGHTS OF ZION MINISTRIES

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		IL

General Provider Information

NPI Number	:	1982038709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTS OF ZION MINISTRIES

Provider Business Mailing Address
First Line	:	11636 S HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-5220
Country	:	US
Telephone Number	:	773-785-2996
Fax Number	:	773-785-3319

Provider Business Practice Location Address
First Line	:	11636 S HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-5220
Country	:	US
Telephone Number	:	773-785-2996
Fax Number	:	773-785-3319

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	MS. ARAINA MICKENS
Credential	:
Telephone Number	:	773-785-2996

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/28/2013

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Directions to “LIGHTS OF ZION MINISTRIES ” Practice Location

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