NPIMap

Organization Active NPI

Ebenezer Family Home, Inc

  • Assisted Living Facility
  • Hialeah, FL
National Provider Identifier
1104071778
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL8519 Issued in FL
Legal business name
EBENEZER FAMILY HOME, INC
Practice address
6690 W 14TH Ave
Hialeah, FL 33012-6239
Phone
(305) 857-9425
Fax
(305) 223-2371
NPI assigned
Nov 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erich Capestany
Title
Administrator
Phone
(786) 376-6767

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL8519 FL Primary

Addresses

Primary practice location

6690 W 14TH Ave
Hialeah, FL 33012-6239

Mailing address

6690 W 14TH Ave
Hialeah, FL 33012-6239
Phone (305) 857-9425

Other identifiers 2

IdentifierTypeStateIssuer
000208100MedicaidFL
000494700MedicaidFL

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1104071778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6690 W 14TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330126239",
            "telephone_number": "305-857-9425",
            "fax_number": "305-223-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6690 W 14TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330126239",
            "telephone_number": "305-857-9425",
            "fax_number": "305-223-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER FAMILY HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-24",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "CAPESTANY",
        "authorized_official_first_name": "ERICH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "786-376-6767"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL8519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000208100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000494700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.