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General NPI Number Information
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NPI Number | 1104074228
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Entity Type | Organization
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Legal Business Name | EBENEZER HOME CARE LLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 1189 MAIN ST
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City | TUNICIA
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State | MS
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Zip | 38676
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Country | US
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Telephone | 662-363-0102
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Fax | 662-363-0103
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Provider Business Mailing Address
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Address Line | 1189 MAIN ST
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City | TUNICIA
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State | MS
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Zip | 38676
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Country | US
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Telephone | 662-541-5009
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Fax | 662-363-0103
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | MR. RODNEY HIBBLER
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Credential |
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Telephone | 662-541-5009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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