# EBENEZER HEALTHCARE SERVICES, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1669874673
- **Authorized official:** MYUNG SOOK SONG (OWNER)
- **Authorized official phone:** (404) 483-6493

## Contact information

- **Practice address:** 4405 INTERNATIONAL BLVD, SUITE B101, NORCROSS, GA 30093-3019
- **Practice address phone:** (770) 806-0009
- **Practice address fax:** (770) 806-0100
- **Mailing address:** 4405 INTERNATIONAL BLVD, SUITE B101, NORCROSS, GA 30093-3019
- **Mailing address phone:** (770) 806-0009
- **Mailing address fax:** (770) 806-0100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 067-R-1183 | GA | Yes |
| 261QA0600X | Adult Day Care Clinic/Center | 067-R-1183 | GA | — |

## Other

- **Enumeration date:** 09/22/2014
- **Last updated:** 06/24/2016