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General NPI Number Information
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NPI Number | 1891501508
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Entity Type | Organization
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Legal Business Name | EBEN EZER LUTHERAN CARE CENTER
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 604 JAY DR
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City | STERLING
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State | CO
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Zip | 80751-4718
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Country | US
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Telephone | 970-842-2861
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Fax |
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Provider Business Mailing Address
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Address Line | 122 HOSPITAL RD
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City | BRUSH
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State | CO
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Zip | 80723-1702
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Country | US
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Telephone | 970-842-2861
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | LESLIE MASON
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Credential |
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Telephone | 970-842-2861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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