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General NPI Number Information
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NPI Number | 1144933268
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Entity Type | Organization
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Legal Business Name | EBENEZER DAYBREAK OF ST. PAUL
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 45 10TH ST W STE 3440
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City | SAINT PAUL
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State | MN
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Zip | 55102-1062
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Country | US
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Telephone | 651-328-4889
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Fax |
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Provider Business Mailing Address
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Address Line | 45 10TH ST W STE 3440
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City | SAINT PAUL
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State | MN
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Zip | 55102-1062
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Country | US
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Telephone | 651-328-4889
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Fax |
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Authorized Official
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Title or Position | CFO ACCOUNTING
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Name | TODD WILLETT
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Credential |
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Telephone | 612-874-3493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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