Ebenezer Etta Healthcare Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

EBENEZER ETTA HEALTHCARE SERVICES LLC

Practice address

4200 Forbes Blvd Ste 1094200
Lanham, MD 20706-4342

Phone

(240) 353-6067

Fax

(667) 290-6344

NPI assigned

Jan 20, 2022

Organization subpart

No

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

Authorized official

Name

Estella Etta

Title

Owner

Phone

(240) 260-8882

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1629720750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 FORBES BLVD STE 1094200",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064342",
            "telephone_number": "240-260-8882",
            "fax_number": "667-290-6344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 FORBES BLVD STE 1094200",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064342",
            "telephone_number": "240-353-6067",
            "fax_number": "667-290-6344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER ETTA HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "ETTA",
        "authorized_official_first_name": "ESTELLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-260-8882"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.