Healthcare Provider Details

I. General information

NPI: 1225214869
Provider Name (Legal Business Name): EBENEZER MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S FRONTAGE RD STE 360B
HASTINGS MN
55033-2491
US

IV. Provider business mailing address

1355 S FRONTAGE RD STE 360B
HASTINGS MN
55033-2491
US

V. Phone/Fax

Practice location:
  • Phone: 651-438-9800
  • Fax: 651-437-4040
Mailing address:
  • Phone: 651-438-9800
  • Fax: 651-437-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1044128
License Number StateMN

VIII. Authorized Official

Name: MS. ERIN HILLIGAN
Title or Position: CAMPUS DIRECTOR
Credential:
Phone: 952-898-8400