Provider Demographics
NPI:1568693778
Name:ZENITH PROVIDERS
Entity Type:Organization
Organization Name:ZENITH PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:LIGHTNER
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-707-4636
Mailing Address - Street 1:3802 BROADACRES DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6502
Mailing Address - Country:US
Mailing Address - Phone:336-855-7936
Mailing Address - Fax:336-855-7936
Practice Address - Street 1:3802 BROADACRES DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-6502
Practice Address - Country:US
Practice Address - Phone:336-471-7663
Practice Address - Fax:336-886-7637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-920322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children