Organization
EBENEZER 24-HR RESIDENTIAL SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIYA WAKJIRA (OWNER)
(971) 678-2102
Entity
Organization
Contact information
Practice address
4711 SE LAKE RD, MILWAUKIE, OR 97222-4745
(971) 678-2102
Mailing address
4711 SE LAKE RD, MILWAUKIE, OR 97222-4745
(971) 678-2102
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
—
Other
Enumeration date
02/16/2026
Last updated
02/16/2026
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