EBONY HOUSE INC NPI 1710161419

NPI Information

NPI: 1710161419
Provider Name: EBONY HOUSE INC
Classification: Counselor - 101YA0400X
Entity Type: Organization

Specialization: Addiction (Substance Use Disorder)

CLIA Number: 03D2157689

Address:
6222 S 13TH ST
PHOENIX, AZ
ZIP 85042
Phone: (602) 276-4288
Get Directions

EBONY HOUSE INC is an addiction (substance use disorder) counselor in Phoenix, AZ. EBONY HOUSE INC NPI is 1710161419. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6222 S 13TH ST
PHOENIX, AZ
ZIP 85042-408
Phone: (602) 276-4288
Fax: (602) 232-2938

The provider's authorized official is William Freeman .
The authorized official title is Ceo and has the following contact phone number (602) 276-4288.

The CLIA number assigned to this NPI record is 03D2157689 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/18/2007 and was last updated on 12/18/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	BH076	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	274629	OTHER	ARIZONA	AHCCCS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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