Provider Demographics
NPI:1629939103
Name:EBENEZER MAON ASSISTED LIVING LLC
Entity type:Organization
Organization Name:EBENEZER MAON ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SERKADIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEBE GETACHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-482-9313
Mailing Address - Street 1:171 BALSAM CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2401
Mailing Address - Country:US
Mailing Address - Phone:513-570-4134
Mailing Address - Fax:
Practice Address - Street 1:171 BALSAM CT
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-2401
Practice Address - Country:US
Practice Address - Phone:513-570-4134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness