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General NPI Number Information
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NPI Number | 1194852616
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Entity Type | Organization
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Legal Business Name | EBENEZER HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 1515 E KEARNEY ST SUITE 100
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City | MESQUITE
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State | TX
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Zip | 75149-7545
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Country | US
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Telephone | 972-289-9400
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Fax | 972-289-9402
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Provider Business Mailing Address
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Address Line | 1515 E. KEARNEY ST SUITE 100
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City | MESQUITE
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State | TX
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Zip | 75149-2688
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Country | US
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Telephone | 972-289-9400
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Fax | 972-289-9402
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. THOMAS A SAMUEL
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Credential |
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Telephone | 972-289-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 010358
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License Number State | TX
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