Provider Demographics
NPI:1356861355
Name:E.B. ENTERPRISES LLC
Entity Type:Organization
Organization Name:E.B. ENTERPRISES LLC
Other - Org Name:SERENITY SENIOR RETREAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIZENDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-662-3839
Mailing Address - Street 1:401 N WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-2857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152
Practice Address - Country:US
Practice Address - Phone:620-326-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility