Organization
ZION LW
Active
Other names
Zion LW
Organization subpart
No
Provider details
NPI number
Authorized official
LIDICE VALENCIA CBHCMS, BA, BS (CEO)
(407) 435-4791
Entity
Organization
Contact information
Practice address
2109 PUTTER PL, KISSIMMEE, FL 34746-3971
(407) 435-4791
Mailing address
2109 PUTTER PL, KISSIMMEE, FL 34746-3971
(407) 435-4791
(407) 264-8357
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
Primary
—
—
251X00000X
Supports Brokerage Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102445600
—
FL
01
—
1295195527
NPI
—
05
—
746004
—
FL
Enumeration date
02/29/2016
Last updated
01/26/2023
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