# EBENEZER HOME OF TENNESSEE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Good Samaritan Health & Rehab Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528120458
- **Authorized official:** MRS. CELIA DAVID VALDOMAR NHA ADMINISTRATOR (PRESIDENT)
- **Authorized official phone:** (310) 995-2603

## Contact information

- **Practice address:** 500 HICKORY HOLLOW TER, ANTIOCH, TN 37013-2115
- **Practice address phone:** (615) 731-7130
- **Practice address fax:** (615) 731-0743
- **Mailing address:** 500 HICKORY HOLLOW TER, ANTIOCH, TN 37013-2115
- **Mailing address phone:** (615) 731-7130
- **Mailing address fax:** (615) 731-0743

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 0000000051 | TN | Yes |

## Other

- **Enumeration date:** 12/15/2006
- **Last updated:** 01/08/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0445170 | — | TN |
| 05 | — | 7440473 | — | TN |