Organization
EBENEZER SOCIETY
Active
Other names
Ebenezer Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. 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
314000000X
Skilled Nursing Facility
Primary
245587
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100344
MEDICA DUAL
MN
05
—
810542100
—
MN
01
—
NA0018
UCARE
MN
Enumeration date
07/07/2005
Last updated
09/13/2011
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