Provider Demographics
NPI:1013148519
Name:ZENITH PROVIDERS, LLC
Entity Type:Organization
Organization Name:ZENITH PROVIDERS, LLC
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:336-272-8000
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 1:7 KELLEY CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-4679
Practice Address - Country:US
Practice Address - Phone:336-272-8000
Practice Address - Fax:336-855-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
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