Provider Demographics
NPI:1477372571
Name:ZION SELAH HOME HEALTHCARE AGENCY LLC
Entity type:Organization
Organization Name:ZION SELAH HOME HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDEMAGEN
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-644-8235
Mailing Address - Street 1:2821 S PARKER RD STE 1017
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2714
Mailing Address - Country:US
Mailing Address - Phone:616-644-8235
Mailing Address - Fax:
Practice Address - Street 1:2821 S PARKER RD STE 2-1017
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2735
Practice Address - Country:US
Practice Address - Phone:616-644-8235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities