Ebenezer Home Care LLC

Primary specialty

HomemakerTaxonomy code 376J00000X

Legal business name

EBENEZER HOME CARE LLC

Practice address

1189 Main St
Tunicia, MS 38676

Phone

(662) 363-0102

Fax

(662) 363-0103

NPI assigned

Sep 3, 2008

Organization subpart

No

Name

Mr. Rodney Hibbler

Title

Administrator/Ceo

Phone

(662) 541-5009

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 22, 2008.

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222041600000",
    "number": "1104074228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1189 MAIN ST",
            "city": "TUNICIA",
            "state": "MS",
            "postal_code": "38676",
            "telephone_number": "662-541-5009",
            "fax_number": "662-363-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1189 MAIN ST",
            "city": "TUNICIA",
            "state": "MS",
            "postal_code": "38676",
            "telephone_number": "662-363-0102",
            "fax_number": "662-363-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-03",
        "last_updated": "2008-09-22",
        "status": "A",
        "authorized_official_last_name": "HIBBLER",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "662-541-5009",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "376J00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07988034",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; 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.