Ebenezer Senior Services, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NCF814 Issued in SC

Legal business name

EBENEZER SENIOR SERVICES, LLC

Doing business as

Agape Rehabilitation of Rock Hill

Practice address

159 Sedgewood Dr
Rock Hill, SC 29732-2315

Phone

(803) 329-6565

Fax

(803) 329-6624

NPI assigned

Jun 10, 2006

Last updated

Jan 13, 2017By 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

Mr. G. Scott Middleton

Title

Ceo, Agape Senior

Phone

(803) 454-0365

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Agape Rehabilitation of Rock Hill Doing business as

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1760423495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 SEDGEWOOD DR",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297322315",
            "telephone_number": "803-329-6565",
            "fax_number": "803-329-6624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 SEDGEWOOD DR",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297322315",
            "telephone_number": "803-329-6565",
            "fax_number": "803-329-6624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER SENIOR SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "MIDDLETON",
        "authorized_official_first_name": "G. SCOTT",
        "authorized_official_title_or_position": "CEO, AGAPE SENIOR",
        "authorized_official_telephone_number": "803-454-0365",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SC",
            "license": "NCF814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0464NF",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Agape Rehabilitation of Rock Hill",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Skilled Nursing Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; 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.