Provider Demographics
NPI:1295195527
Name:ZION LW
Entity Type:Organization
Organization Name:ZION LW
Other - Org Name:ZION LW
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:CBHCMS, BA, BS
Authorized Official - Phone:407-435-4791
Mailing Address - Street 1:2109 PUTTER PL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3971
Mailing Address - Country:US
Mailing Address - Phone:407-435-4791
Mailing Address - Fax:407-264-8357
Practice Address - Street 1:2109 PUTTER PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3971
Practice Address - Country:US
Practice Address - Phone:407-435-4791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL746004Medicaid
FL102445600Medicaid
1295195527OtherNPI