1194852616 NPI number — EBENEZER HOME HEALTH CARE LLC

Table of content: (NPI 1194852616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194852616 NPI number — EBENEZER HOME HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EBENEZER HOME 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:
6
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:
1194852616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 E. KEARNEY ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75149-2688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-289-9400
Provider Business Mailing Address Fax Number:
972-289-9402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 E KEARNEY ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75149-7545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-289-9400
Provider Business Practice Location Address Fax Number:
972-289-9402
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAMUEL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
972-289-9400

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  010358 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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