Ebenezer House I , Llc

LBN: Ebenezer House I , Llc
Ebenezer House I , Llc is an health care organization with primary practice located at 4055 N 77Th Dr , Phoenix AZ 85033-3618. The organization recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as the primary health care specialty. Ebenezer House I , Llc can be contacted via phone (623) 440-4404, or through Nibizi, Eric via phone (623) 440-4404.

Contact Information

Primary practice address
4055 N 77Th Dr Phoenix AZ 85033-3618
Phone: (623) 440-4404
Fax: (623) 777-0082
Website:
Map and Directions
Authorized official contact:
Name: Nibizi, Eric
Phone: (623) 440-4404

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X

Profile Details

NPI number 1407426273
LBN Legal business name Ebenezer House I , Llc
DBA Doing business as
Authorized official Nibizi, Eric
Entity Organization
Organization subpart 1 No
Enumeration date Jun 24th, 2021
Last updated Jun 24th, 2021 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407426273 NPPES
Arizona MEDICAID 0000

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