Provider Demographics
NPI:1518649995
Name:AM4ZLLC
Entity Type:Organization
Organization Name:AM4ZLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SA'JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERHART
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:614-290-0033
Mailing Address - Street 1:1958 BURROUGHS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4418
Mailing Address - Country:US
Mailing Address - Phone:614-290-0033
Mailing Address - Fax:
Practice Address - Street 1:1958 BURROUGHS DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4418
Practice Address - Country:US
Practice Address - Phone:614-290-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities