Provider Demographics
NPI:1891501508
Name:EBEN EZER LUTHERAN CARE CENTER
Entity type:Organization
Organization Name:EBEN EZER LUTHERAN CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-842-2861
Mailing Address - Street 1:122 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-1702
Mailing Address - Country:US
Mailing Address - Phone:970-842-2861
Mailing Address - Fax:
Practice Address - Street 1:604 JAY DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4718
Practice Address - Country:US
Practice Address - Phone:970-842-2861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility