EBENEZER ADULT DAY PROGRAM NPI 1174508873

NPI Information

NPI: 1174508873
Provider Name: EBENEZER ADULT DAY PROGRAM
Classification: Clinic/Center - 261QA0600X
Entity Type: Organization

Specialization: Adult Day Care

CLIA Number: 24D0861875

Address:
2545 PORTLAND AVE
MINNEAPOLIS, MN
ZIP 55404
Phone: (612) 879-2262
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EBENEZER ADULT DAY PROGRAM is an adult day care clinic center in Minneapolis, MN. EBENEZER ADULT DAY PROGRAM NPI is 1174508873. The provider is registered as an organization entity type.

The provider's business location address is:

2545 PORTLAND AVE
MINNEAPOLIS, MN
ZIP 55404-406
Phone: (612) 879-2262
Fax: (612) 879-2316

The provider's authorized official is Mark Thomas .
The authorized official title is President/ceo and has the following contact phone number (612) 874-3460.

The CLIA number assigned to this NPI record is 24D0861875 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/14/2005 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA0600X	Clinic/Center	Adult Day Care	800713-2-ADC	MINNESOTA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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