Provider Demographics
NPI:1295900785
Name:ZION FOUNDATION FOR CITIZENS
Entity type:Organization
Organization Name:ZION FOUNDATION FOR CITIZENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASPER
Authorized Official - Middle Name:ONYEKACHI
Authorized Official - Last Name:EZEIGBO
Authorized Official - Suffix:JR
Authorized Official - Credentials:BA, MA
Authorized Official - Phone:240-375-3342
Mailing Address - Street 1:6129 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2754
Mailing Address - Country:US
Mailing Address - Phone:301-731-5195
Mailing Address - Fax:301-577-4292
Practice Address - Street 1:6129 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2754
Practice Address - Country:US
Practice Address - Phone:301-731-5195
Practice Address - Fax:301-577-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE221373662628343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC026992800Medicaid