Provider Demographics
NPI:1548426463
Name:ZION LLC
Entity Type:Organization
Organization Name:ZION LLC
Other - Org Name:ZION HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VALLANTINE
Authorized Official - Middle Name:EBOT
Authorized Official - Last Name:ATEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-481-6005
Mailing Address - Street 1:2403 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3036
Mailing Address - Country:US
Mailing Address - Phone:612-481-6005
Mailing Address - Fax:651-698-9466
Practice Address - Street 1:2403 STEWART AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3036
Practice Address - Country:US
Practice Address - Phone:612-481-6001
Practice Address - Fax:651-698-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR183439-8251E00000X
MNL061734-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN263982000OtherMDHS(DHS)