Provider Demographics
NPI:1467500694
Name:MT. ZION CARE SPECIALE, LLC
Entity Type:Organization
Organization Name:MT. ZION CARE SPECIALE, LLC
Other - Org Name:MT. ZION
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:SOTELO
Authorized Official - Last Name:DOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:BS IN BUSINESS ADM
Authorized Official - Phone:626-864-8854
Mailing Address - Street 1:2025 CARLOS ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-4432
Mailing Address - Country:US
Mailing Address - Phone:626-864-8854
Mailing Address - Fax:323-461-0432
Practice Address - Street 1:4643 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3101
Practice Address - Country:US
Practice Address - Phone:323-461-0588
Practice Address - Fax:323-461-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200318210050251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health