1881970275 NPI number — EBENEZER BLESSING SERVICES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881970275 NPI number — EBENEZER BLESSING SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EBENEZER BLESSING SERVICES INC.
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:
1881970275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5428 ROCKY MOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76137-4464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-683-8739
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5428 ROCKY MOUNTAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76137-4464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-683-8739
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
817-683-8739

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  11537521 , 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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