NPIMap

Organization Active NPI

Ebenezer Society, LLC

Doing business as Ebenezer Home Care

  • Home Health Agency
  • Wyoming, MN
National Provider Identifier
1477968550
Registry record updated Jun 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
23170 Issued in MN
Legal business name
EBENEZER SOCIETY, LLC
Doing business as
Ebenezer Home Care
Practice address
25565 Fairview Ave
Wyoming, MN 55092-8053
Phone
(651) 982-6228
NPI assigned
Jun 26, 2014
Last updated
Jun 26, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

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

Authorized official

Name
Jill Nokleby Kaiser
Title
Director of Housing Development
Phone
(612) 874-3431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 23170 MN Primary

Addresses

Primary practice location

25565 Fairview Ave
Wyoming, MN 55092-8053

Mailing address

25565 Fairview Ave
Wyoming, MN 55092-8053
Phone (651) 982-6228

Other names 1

  • Ebenezer Home Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ebenezer Home Care7 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.

NPI Registry JSON

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1477968550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25565 FAIRVIEW AVE",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550928053",
            "telephone_number": "651-982-6228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25565 FAIRVIEW AVE",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550928053",
            "telephone_number": "651-982-6228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER SOCIETY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-26",
        "last_updated": "2014-06-26",
        "status": "A",
        "authorized_official_last_name": "KAISER",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "NOKLEBY",
        "authorized_official_title_or_position": "DIRECTOR OF HOUSING DEVELOPMENT",
        "authorized_official_telephone_number": "612-874-3431"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "23170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ebenezer Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wyoming, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; 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.