NPIMap

Organization Active NPI

Ebenezer Home Care

  • Home Health Agency
  • Minneapolis, MN
National Provider Identifier
1356636344
Registry record updated Jun 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
27773 Issued in MN
Legal business name
EBENEZER HOME CARE
Practice address
2625 Park Ave
Minneapolis, MN 55407-1016
Phone
(612) 871-4574
Fax
(612) 872-7368
NPI assigned
Jun 17, 2011
Organization subpart
Yes
Parent organization
EBENEZER SOCIETYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2011

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

Authorized official

Name
Stephan Grygar
Title
Cfo
Phone
(612) 874-3477

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 27773 MN Primary

Addresses

Primary practice location

2625 Park Ave
Minneapolis, MN 55407-1016

Mailing address

2625 Park Ave
Minneapolis, MN 55407-1016
Phone (612) 871-4574

National Provider Directory

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

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1308268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308268800000",
    "number": "1356636344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071016",
            "telephone_number": "612-871-4574",
            "fax_number": "612-872-7368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071016",
            "telephone_number": "612-871-4574",
            "fax_number": "612-872-7368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HOME CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EBENEZER SOCIETY",
        "enumeration_date": "2011-06-17",
        "last_updated": "2011-06-17",
        "status": "A",
        "authorized_official_last_name": "GRYGAR",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "612-874-3477"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "27773",
            "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 Jun 17, 2011; 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.