Provider Demographics
NPI:1487201927
Name:EPHESIANS 2:10 HOLDINGS, LLC
Entity Type:Organization
Organization Name:EPHESIANS 2:10 HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-961-1795
Mailing Address - Street 1:8919 THOMPSON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7604
Mailing Address - Country:US
Mailing Address - Phone:281-961-1795
Mailing Address - Fax:
Practice Address - Street 1:1415 SH-6, SUITE A-310
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-961-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care