Provider Demographics
NPI:1982038709
Name:LIGHTS OF ZION MINISTRIES
Entity Type:Organization
Organization Name:LIGHTS OF ZION MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-785-2996
Mailing Address - Street 1:11636 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-5220
Mailing Address - Country:US
Mailing Address - Phone:773-785-2996
Mailing Address - Fax:773-785-3319
Practice Address - Street 1:11636 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-5220
Practice Address - Country:US
Practice Address - Phone:773-785-2996
Practice Address - Fax:773-785-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL251E00000XMedicare PIN