Provider Demographics
NPI:1336793736
Name:EBENEZERY ADULT DAY SERVICES, LLC
Entity Type:Organization
Organization Name:EBENEZERY ADULT DAY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MORIAM
Authorized Official - Middle Name:OMOLARA
Authorized Official - Last Name:ADEGBITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-901-1314
Mailing Address - Street 1:6321 JAHNKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4142
Mailing Address - Country:US
Mailing Address - Phone:804-447-5635
Mailing Address - Fax:804-447-8737
Practice Address - Street 1:6321 JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4142
Practice Address - Country:US
Practice Address - Phone:804-447-5635
Practice Address - Fax:804-447-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care