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Organization
EBENEZER HEALTHCARE SERVICES
Active
Organization
EBENEZER HEALTHCARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYUNG S SONG (OWNER)
47029945464
Entity
Organization
Contact information
Practice address
5380 PEACHTREE INDUSTRIAL BLVD, SUITE 247 AB, NORCROSS, GA 30071-4713
(470) 299-4564
Mailing address
5380 PEACHTREE INDUSTRIAL BLVD STE 247, NORCROSS, GA 30071-1592
(470) 299-4564
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
067-R-1183
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003160947A
—
GA
Enumeration date
10/12/2015
Last updated
10/12/2015
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