NPIMap

Organization Active NPI

Ebenezer Home Health Care LLC

Doing business as Ebenezer Home Health

  • Home Health Agency
  • Mesquite, TX
National Provider Identifier
1194852616
Registry record updated Feb 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
010358 Issued in TX
Legal business name
EBENEZER HOME HEALTH CARE LLC
Doing business as
Ebenezer Home Health
Practice address
1515 E Kearney St
Suite 100
Mesquite, TX 75149-7545
Phone
(972) 289-9400
Fax
(972) 289-9402
NPI assigned
Feb 28, 2007
Last updated
Feb 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2009

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

Authorized official

Name
Mr. Thomas A Samuel
Title
Administrator
Phone
(972) 289-9400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 010358 TX Primary

Addresses

Primary practice location

1515 E Kearney St
Suite 100
Mesquite, TX 75149-7545

Mailing address

1515 E. Kearney St
Suite 100
Mesquite, TX 75149-2688
Phone (972) 289-9400

Other names 1

  • Ebenezer Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070425000308 TX Part A Provider - Home Health Agency 5294743233 Practice locations: Mesquite, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194852616. Details of each certification follow.

Home health agency certification: CCN 677948

Legal name
EBENEZER HOME HEALTH CARE LLC
Doing business as
EBENEZER HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 5, 2006
Last certification
Aug 5, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
1515 E Kearney St
Suite 100
Mesquite, TX 75149-7545

Care Compare: Home health agency

Medicare Care Compare
Listed as
Ebenezer Home HealthCCN 677948 · All quality measures
Overall star rating
1.5 of 5
Ownership
Proprietary
Certified
Jun 5, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1050047Ebenezer Home Health Care LLC1515 E Kearney Street, Suite 100, Mesquite, TX 75149Certificate of waiverJan 23, 2028

National Provider Directory

National Provider Directory

Locations

1515 E Kearney St
Ste 100
Mesquite, TX 75149
Phone (972) 289-9400

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Thomas Samuel Individual Corporate Director Mar 26, 2007
W-2 Managing Employee Mar 26, 2007
Anne Thomas Individual 5% Or Greater Direct Ownership Interest Mar 26, 2007
General Partnership Interest Mar 26, 2007
Corporate Director Mar 26, 2007
W-2 Managing Employee Mar 26, 2007

Practitioners & affiliated clinicians

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233878400000",
    "number": "1194852616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E. KEARNEY ST",
            "address_2": "SUITE 100",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751492688",
            "telephone_number": "972-289-9400",
            "fax_number": "972-289-9402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E KEARNEY ST",
            "address_2": "SUITE 100",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751497545",
            "telephone_number": "972-289-9400",
            "fax_number": "972-289-9402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HOME HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2009-02-06",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "972-289-9400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "010358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ebenezer Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesquite, TX

Sources for this page

Verify at the official NPI Registry.