Organization
EBENEZER GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILTON B TRAVERS BSN (RN)
(701) 730-7944
Entity
Organization
Contact information
Practice address
1781 35TH ST S, FARGO, ND 58103-4875
(701) 730-7944
Mailing address
1781 35TH ST S, FARGO, ND 58103-4875
(701) 730-7944
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005876569
—
ND
Enumeration date
07/07/2022
Last updated
07/07/2022
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