Ebenezer Healthcare Services, Inc.

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

067-R-1183 Issued in GA

Legal business name

EBENEZER HEALTHCARE SERVICES, INC.

Practice address

4405 International Blvd
Suite B101
Norcross, GA 30093-3019

Phone

(770) 806-0009

Fax

(770) 806-0100

NPI assigned

Sep 22, 2014

Organization subpart

No

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

Authorized official

Name

Myung Sook Song

Title

Owner

Phone

(404) 483-6493

Specialties & licenses 2

Addresses

Tax ID family

Ebenezer Healthcare Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Ebenezer Healthcare Services

  • In Home Supportive Care Agency
  • Norcross, GA
  • NPI 1285005645
  NPD tax ID

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466726400000",
    "number": "1669874673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 INTERNATIONAL BLVD",
            "address_2": "SUITE B101",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300933019",
            "telephone_number": "770-806-0009",
            "fax_number": "770-806-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 INTERNATIONAL BLVD",
            "address_2": "SUITE B101",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300933019",
            "telephone_number": "770-806-0009",
            "fax_number": "770-806-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-22",
        "last_updated": "2016-06-24",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "MYUNG",
        "authorized_official_middle_name": "SOOK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-483-6493"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "GA",
            "license": "067-R-1183",
            "primary": true
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "GA",
            "license": "067-R-1183",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ingrid Duva, RN
• Chad Ryan Dybdahl, A.T.C.
• Eastside Dental Group
• Easy Dental Care Center PC
• Ebenezer Healthcare Services
• April Michelle Edwards, ARNP
• Ehi Pharmacy Solutions, LLC.
• Jennifer Elliott Ehrhardt, M.ED., CCC-SLP
• Mohamed Eid, O.D.
• David M Eifert, CNIM, R. EEG T.

• In Home Supportive Care Agency in Norcross, GA
• Providers in Norcross, GA by specialty
• In Home Supportive Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; 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.