Healthcare Provider Details

I. General information

NPI: 1134912017
Provider Name (Legal Business Name): EBENEZER OF MB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 HIGHWAY 17 S
NORTH MYRTLE BEACH SC
29582-4343
US

IV. Provider business mailing address

2423 HIGHWAY 17 S
NORTH MYRTLE BEACH SC
29582-4343
US

V. Phone/Fax

Practice location:
  • Phone: 843-306-9922
  • Fax: 843-808-5020
Mailing address:
  • Phone: 843-306-9922
  • Fax: 843-808-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. JONATHAN FRANCIS
Title or Position: OWNER
Credential:
Phone: 843-306-9922