Provider Demographics
NPI:1891453890
Name:ZION MEDICAL TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:ZION MEDICAL TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORVIL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTER NURSE
Authorized Official - Phone:612-703-3373
Mailing Address - Street 1:13770 FRONTIER CT STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4811
Mailing Address - Country:US
Mailing Address - Phone:651-808-2866
Mailing Address - Fax:
Practice Address - Street 1:13770 FRONTIER CT
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4810
Practice Address - Country:US
Practice Address - Phone:651-808-2866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health