MEDICARE: EBENEZER COTTAGE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1861341059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBENEZER COTTAGE CARE LLC

Provider Business Mailing Address
First Line	:	200 PROSPERITY DR STE 133
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4718
Country	:	US
Telephone Number	:	865-226-9075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 TEXAS AVENUE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920
Country	:	US
Telephone Number	:	865-226-9075
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. INNOCENT RUDASINGWA
Credential	:
Telephone Number	:	865-226-9075

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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