Provider Demographics
NPI:1437617156
Name:EBENEZER FAMILY HOME III LLC
Entity Type:Organization
Organization Name:EBENEZER FAMILY HOME III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN.
Authorized Official - Prefix:
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 1:18309 SW 114TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4989
Mailing Address - Country:US
Mailing Address - Phone:305-256-9902
Mailing Address - Fax:305-351-8782
Practice Address - Street 1:18309 SW 114TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-4989
Practice Address - Country:US
Practice Address - Phone:305-256-9902
Practice Address - Fax:305-351-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility