Healthcare Provider Details

I. General information

NPI: 1710743620
Provider Name (Legal Business Name): EBENEZER OPERATIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GRASSY VIEW DR
FORT WORTH TX
76177-7550
US

IV. Provider business mailing address

213 DARLINGTON TRL
FORT WORTH TX
76131-3583
US

V. Phone/Fax

Practice location:
  • Phone: 682-347-2228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: UTOMWEN TESSY AIKPITANYI
Title or Position: PRESIDENT
Credential:
Phone: 682-347-2228