Organization
EBENEZER ADULT DAY PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK THOMAS (PRESIDENT/CEO)
(612) 874-3460
Entity
Organization
Contact information
Practice address
2545 PORTLAND AVE, MINNEAPOLIS, MN 55404-4406
(612) 879-2262
(612) 879-2316
Mailing address
2545 PORTLAND AVE, MINNEAPOLIS, MN 55404-4406
(612) 879-2262
(612) 879-2316
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
800713-2-ADC
MN
Other
Enumeration date
12/14/2005
Last updated
08/22/2020
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