Organization
EBENEZER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETHEL ESHETU TADESSE NP (DIRECTOR)
(240) 423-5267
Entity
Organization
Contact information
Practice address
4055 NE 218TH AVE, FAIRVIEW, OR 97024-8778
(240) 423-5267
Mailing address
4055 NE 218TH AVE, FAIRVIEW, OR 97024-8778
(240) 423-5267
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
03/27/2026
Last updated
03/27/2026
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