Provider Demographics
NPI:1144590001
Name:EBENEZER FAMILY HOME 2
Entity Type:Organization
Organization Name:EBENEZER FAMILY HOME 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPESTANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-376-6767
Mailing Address - Street 1:1024 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1817
Mailing Address - Country:US
Mailing Address - Phone:305-857-9425
Mailing Address - Fax:
Practice Address - Street 1:1024 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-1817
Practice Address - Country:US
Practice Address - Phone:305-857-9425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12048310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility