Provider Demographics
NPI:1215722855
Name:EBENEZER HOME CARE LLC
Entity type:Organization
Organization Name:EBENEZER HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANADILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-548-0680
Mailing Address - Street 1:807 BROAD ST RM 354
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1678
Mailing Address - Country:US
Mailing Address - Phone:401-548-0680
Mailing Address - Fax:
Practice Address - Street 1:807 BROAD ST RM 354
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1678
Practice Address - Country:US
Practice Address - Phone:401-548-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health