Provider Demographics
NPI:1699819276
Name:EBENEZER RIDGES ADULT DAY CENTER
Entity Type:Organization
Organization Name:EBENEZER RIDGES ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-898-8410
Mailing Address - Street 1:13810 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4593
Mailing Address - Country:US
Mailing Address - Phone:952-898-3085
Mailing Address - Fax:952-898-8450
Practice Address - Street 1:13810 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4593
Practice Address - Country:US
Practice Address - Phone:952-898-3085
Practice Address - Fax:952-898-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800712-2-ADC261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800712OtherADULT DAY CENTER