EBENEZER HOUSE LLC NPI 1891262556

NPI Information

NPI: 1891262556
Provider Name: EBENEZER HOUSE, LLC
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
4055 N 77TH DR
PHOENIX, AZ
ZIP 85033
Phone: (602) 686-3318
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EBENEZER HOUSE, LLC is a community based residential treatment facility mental illness in Phoenix, AZ. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. EBENEZER HOUSE, LLC NPI is 1891262556. The provider is registered as an organization entity type.

The provider's business location address is:

4055 N 77TH DR
PHOENIX, AZ
ZIP 85033-618
Phone: (602) 686-3318

The provider's authorized official is Nigel Santiago .
The authorized official title is Chief Executive Officer and has the following contact phone number (602) 686-3318.

The enumeration date for this NPI number is 10/30/2018 and was last updated on 10/30/2018.

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	320800000X	Community Based Residential Treatment Facility, Mental Illness				Yes

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: 4/28/2024

NPI Synchronization or Removal

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