Provider Demographics
NPI:1447083563
Name:EBENEZER KIDS THERAPY MULTIDISCIPLINARY CENTER INC
Entity type:Organization
Organization Name:EBENEZER KIDS THERAPY MULTIDISCIPLINARY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MRS
Authorized Official - Phone:939-377-0884
Mailing Address - Street 1:PO BOX 3578
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-3578
Mailing Address - Country:US
Mailing Address - Phone:939-377-0884
Mailing Address - Fax:
Practice Address - Street 1:BO. ESPINOSA
Practice Address - Street 2:CARR 679 KM 3
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:939-377-0884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty