Ebonny Home Health Agency Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

EBONNY HOME HEALTH AGENCY INC

Doing business as

Ebonny Home Health Agency

Practice address

1101 N Decatur Blvd
Las Vegas, NV 89108-1220

Phone

(702) 399-7154

Fax

(866) 528-6506

NPI assigned

Jun 6, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Moses Irubor

Title

President

Phone

(281) 235-3417

Specialties & licenses 1

Addresses

Other names 1

• EBONNY HOME HEALTH AGENCY Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Home health agency certification: CCN 297141

Legal name

EBONNY HOME HEALTH AGENCY INC

Doing business as

EBONNY HOME HEALTH AGENCY

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Feb 22, 2008

Last certification

Nov 8, 2019

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Jun 5, 2013 in NV

Enrollment address

3530 E Flamingo Rd
Ste 105
Las Vegas, NV 89121-5091

Listed as

Ebonny Home Health AgencyCCN 297141 · All quality measures

Overall star rating

1 of 5

Ownership

Proprietary

Certified

Feb 22, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1003254400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 N DECATUR BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891081220",
            "telephone_number": "702-399-7154",
            "fax_number": "866-528-6506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N DECATUR BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891081220",
            "telephone_number": "702-399-7154",
            "fax_number": "866-528-6506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBONNY HOME HEALTH AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-06",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "IRUBOR",
        "authorized_official_first_name": "MOSES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "281-235-3417",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EBONNY HOME HEALTH AGENCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Emmanuel Ebo
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• Ebonny Behavioral Care Services Corporation
• Ebonny Ventures Inc (Nevada Treatment Center)
• Ebonny Ventures LLC (Ozomor Psychiatric Services)
• Ebony Relief Charitable Inc. (Ika Wellness)
• Kimberly Sue Ebrahimi, APRN
• Sheida Ebrahimi, MD

• Home Health Agency in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Home Health Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.