Organization
EBENEZER HOME OF TENNESSEE, INC.
Active
Other names
Good Samaritan Health & Rehab Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CELIA DAVID VALDOMAR NHA ADMINISTRATOR (PRESIDENT)
(310) 995-2603
Entity
Organization
Contact information
Practice address
500 HICKORY HOLLOW TER, ANTIOCH, TN 37013-2115
(615) 731-7130
(615) 731-0743
Mailing address
500 HICKORY HOLLOW TER, ANTIOCH, TN 37013-2115
(615) 731-7130
(615) 731-0743
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0000000051
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445170
—
TN
05
—
7440473
—
TN
Enumeration date
12/15/2006
Last updated
01/08/2019
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