Provider Demographics
NPI:1265272207
Name:ZELEVIE OUTPATIENT THERAPY LLC
Entity type:Organization
Organization Name:ZELEVIE OUTPATIENT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-675-4545
Mailing Address - Street 1:201 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-3374
Mailing Address - Country:US
Mailing Address - Phone:505-675-4545
Mailing Address - Fax:505-436-2763
Practice Address - Street 1:201 NELSON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-3374
Practice Address - Country:US
Practice Address - Phone:505-675-4545
Practice Address - Fax:505-436-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)