Provider Demographics
NPI:1700508793
Name:ZELEVIE HEALTH OF WACO LLC
Entity Type:Organization
Organization Name:ZELEVIE HEALTH OF WACO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:RASBAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-200-9142
Mailing Address - Street 1:5801 CROSSLAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6962
Mailing Address - Country:US
Mailing Address - Phone:801-683-6565
Mailing Address - Fax:
Practice Address - Street 1:5801 CROSSLAKE PKWY
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6962
Practice Address - Country:US
Practice Address - Phone:801-683-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility