NPIMap

Organization Active NPI

Ebenezer Adult Day Program

  • Adult Day Care Clinic/Center
  • Minneapolis, MN
National Provider Identifier
1174508873
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
800713-2-ADC Issued in MN
Legal business name
EBENEZER ADULT DAY PROGRAM
Practice address
2545 Portland Ave
Minneapolis, MN 55404-4406
Phone
(612) 879-2262
Fax
(612) 879-2316
NPI assigned
Dec 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mark Thomas
Title
President/Ceo
Phone
(612) 874-3460

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X 800713-2-ADC MN Primary

Addresses

Primary practice location

2545 Portland Ave
Minneapolis, MN 55404-4406

Mailing address

2545 Portland Ave
Minneapolis, MN 55404-4406
Phone (612) 879-2262

National Provider Directory

National Provider Directory
Tax ID family
Ebenezer Society7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2545 Portland Ave
Minneapolis, MN 55404
Phone (612) 879-2262

NPI Registry JSON

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174508873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044406",
            "telephone_number": "612-879-2262",
            "fax_number": "612-879-2316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044406",
            "telephone_number": "612-879-2262",
            "fax_number": "612-879-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER ADULT DAY PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "612-874-3460"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "MN",
            "license": "800713-2-ADC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.