Organization
EBENEZER HEALTHCARE SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYUNG SOOK SONG (OWNER)
(404) 483-6493
Entity
Organization
Contact information
Practice address
4405 INTERNATIONAL BLVD, SUITE B101, NORCROSS, GA 30093-3019
(770) 806-0009
(770) 806-0100
Mailing address
4405 INTERNATIONAL BLVD, SUITE B101, NORCROSS, GA 30093-3019
(770) 806-0009
(770) 806-0100
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
067-R-1183
GA
261QA0600X
Adult Day Care Clinic/Center
067-R-1183
GA
Other
Enumeration date
09/22/2014
Last updated
06/24/2016
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