Provider Demographics
NPI:1457734519
Name:ZORITA KOENIG HOME CARE
Entity Type:Organization
Organization Name:ZORITA KOENIG HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZORITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-379-1146
Mailing Address - Street 1:12528 BELMONT LAKES DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5968
Mailing Address - Country:US
Mailing Address - Phone:904-379-1146
Mailing Address - Fax:904-379-1146
Practice Address - Street 1:12528 BELMONT LAKES DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-5968
Practice Address - Country:US
Practice Address - Phone:904-379-1146
Practice Address - Fax:904-379-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229024251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1447696042Medicaid