Provider Demographics
NPI:1831797679
Name:ETHEL LEE ZACHARY FOUNDATION
Entity type:Organization
Organization Name:ETHEL LEE ZACHARY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AMANHOTEP
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:VI
Authorized Official - Credentials:
Authorized Official - Phone:267-386-6361
Mailing Address - Street 1:5400 LANSDOWNE AVE APT G2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3916
Mailing Address - Country:US
Mailing Address - Phone:267-386-6361
Mailing Address - Fax:
Practice Address - Street 1:5400 LANSDOWNE AVE APT G2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-3916
Practice Address - Country:US
Practice Address - Phone:267-386-6361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health