Provider Demographics
NPI:1568261378
Name:EBENEZER HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:EBENEZER HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COMFORT
Authorized Official - Middle Name:TUMI
Authorized Official - Last Name:ADEWALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-607-9368
Mailing Address - Street 1:148 CLUBHOUSE DR APT 29
Mailing Address - Street 2:
Mailing Address - City:HOLLINS
Mailing Address - State:VA
Mailing Address - Zip Code:24019-6134
Mailing Address - Country:US
Mailing Address - Phone:931-266-7718
Mailing Address - Fax:
Practice Address - Street 1:109 E LEE AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-2517
Practice Address - Country:US
Practice Address - Phone:931-266-7718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care