Provider Demographics
NPI:1558773325
Name:ZION'S II ASSISTED LIVING FACILITY,INC
Entity Type:Organization
Organization Name:ZION'S II ASSISTED LIVING FACILITY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHYNE-KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-693-0282
Mailing Address - Street 1:256 BARBAROSSA RD NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1809
Mailing Address - Country:US
Mailing Address - Phone:321-693-0282
Mailing Address - Fax:
Practice Address - Street 1:256 BARBAROSSA RD NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1809
Practice Address - Country:US
Practice Address - Phone:321-693-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11317310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility