1164877833 NPI number — ZION HEALTH CARE LLC

Table of content: DR. DARYL KERRY RICHEY PH.D. (NPI 1023032109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164877833 NPI number — ZION HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZION HEALTH CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164877833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1470 NW 107TH AVE
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33172-2744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-886-3400
Provider Business Mailing Address Fax Number:
305-594-0088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11389 W FLAGLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33174-1185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-886-3400
Provider Business Practice Location Address Fax Number:
786-886-3401
Provider Enumeration Date:
04/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MARRERO
Authorized Official First Name:
JULIETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-886-3400

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  MH 11022 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020002402 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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