NPIMap

Organization Active NPI

Ebenezer Management Services

Doing business as Ebenezer Home Care

  • Assisted Living Facility
  • Wayzata, MN
National Provider Identifier
1881005775
Registry record updated May 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
28636 Issued in MN
Legal business name
EBENEZER MANAGEMENT SERVICES
Doing business as
Ebenezer Home Care
Practice address
875 Wayzata Blvd W
Wayzata, MN 55391-9418
Phone
(952) 473-6655
Fax
(952) 473-6677
NPI assigned
May 13, 2014
Last updated
May 13, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2014

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 28636 MN Primary

Addresses

Primary practice location

875 Wayzata Blvd W
Wayzata, MN 55391-9418

Mailing address

875 Wayzata Blvd W
Wayzata, MN 55391-9418
Phone (952) 473-6655

Other names 1

  • Ebenezer Home Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hastings Daybreak4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1881005775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 WAYZATA BLVD W",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553919418",
            "telephone_number": "952-473-6655",
            "fax_number": "952-473-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 WAYZATA BLVD W",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553919418",
            "telephone_number": "952-473-6655",
            "fax_number": "952-473-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER MANAGEMENT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "NOKLEBY",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "DIRECTOR OF HOUSING DEVELOPMENT",
        "authorized_official_telephone_number": "612-874-3431"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "28636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ebenezer Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wayzata, MN

Sources for this page

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