# EBENEZER REST HOME LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114551116
- **Authorized official:** JANE F NAMULONDO (OWNER)
- **Authorized official phone:** (781) 244-7270

## Contact information

- **Practice address:** 18909 RED OAK LN, TRIANGLE, VA 22172-2122
- **Practice address phone:** (812) 447-2707
- **Mailing address:** 18909 RED OAK LN, TRIANGLE, VA 22172-2122
- **Mailing address phone:** (812) 447-2707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NULL | Yes |

## Other

- **Enumeration date:** 02/27/2020
- **Last updated:** 02/27/2020