Provider Demographics
NPI:1063508802
Name:EBENEZER AMBULANCE INC.
Entity Type:Organization
Organization Name:EBENEZER AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:COLON
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-721-7413
Mailing Address - Street 1:PO BOX 9065095
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00906-5095
Mailing Address - Country:US
Mailing Address - Phone:787-721-7413
Mailing Address - Fax:
Practice Address - Street 1:AVE FERNANDEZ JUNCOS PTA DE TIERRA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00906-5095
Practice Address - Country:US
Practice Address - Phone:787-721-7413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB 4203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport