| Ebenezer Wellness Center Inc | |
|
1200 Nw 78th Ave Ste 210 Doral FL 33126-1817 | |
| (786) 285-3438 | |
| Not Available |
| Full Name | Ebenezer Wellness Center Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1200 Nw 78th Ave Ste 210, Doral, Florida |
| Authorized Official Name and Position | Indira Jimenez (OWNER) |
| Authorized Official Contact | 7862853438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebenezer Wellness Center Inc 1200 Nw 78th Ave Ste 210 Doral FL 33126-1817 Ph: () - | Ebenezer Wellness Center Inc 1200 Nw 78th Ave Ste 210 Doral FL 33126-1817 Ph: (786) 285-3438 |
| NPI Number | 1265007207 |
|---|---|
| Provider Enumeration Date | 05/21/2021 |
| Last Update Date | 03/20/2023 |
| Certification Date | 03/20/2023 |
| Medicare PECOS PAC ID | 2668860248 |
|---|---|
| Medicare Enrollment ID | O20211101002371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265007207 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Juan Diego Oms |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508067679 PECOS PAC ID: 2769674795 Enrollment ID: I20101206001231 |
| Provider Name | Robert Coleman Stewart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619407475 PECOS PAC ID: 0547661175 Enrollment ID: I20210702000259 |
| Provider Name | Angela Maria Hansen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235685181 PECOS PAC ID: 6002212255 Enrollment ID: I20210914000281 |
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