Eben-Ezer Group Home

Primary specialty

Child Intellectual and/or Developmental Disabilities Respite CareTaxonomy code 385HR2060X

License

151427 Issued in FL

Legal business name

EBEN-EZER GROUP HOME

Doing business as

none

Practice address

1688 SW Burlington St
Port St Lucie, FL 34984-3559

Phone

(772) 240-6636

Fax

(772) 249-7004

NPI assigned

May 12, 2011

Last updated

May 12, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Eveline Charles, NURSING ASSISTANCE

Title

Administrator/Owner

Phone

(772) 240-6636

Specialties & licenses 1

Addresses

Other names 1

• none Doing business as

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

{
    "created_epoch": "1305158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305158400000",
    "number": "1588956320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1688 SW BURLINGTON ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349843559",
            "telephone_number": "772-240-6636",
            "fax_number": "772-249-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1688 SW BURLINGTON ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349843559",
            "telephone_number": "772-240-6636",
            "fax_number": "772-249-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBEN-EZER GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-12",
        "last_updated": "2011-05-12",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "EVELINE",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "772-240-6636",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NURSING ASSISTANCE"
    },
    "taxonomies": [
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "FL",
            "license": "151427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "none",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Child Intellectual and/or Developmental Disabilities Respite Care in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Child Intellectual and/or Developmental Disabilities Respite Care in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.