Individual
EBONY WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5122 CEDARWOOD LN, SOUTH BEND, IN 46619-1607
(574) 904-4212
Mailing address
5122 CEDARWOOD LN, SOUTH BEND, IN 46619-1607
(574) 904-4212
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
21-015359-1
IN
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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