NPIMap

Organization Active NPI

Ebony House Inc

  • Substance Abuse Rehabilitation Facility
  • Phoenix, AZ
National Provider Identifier
1023170933
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
BH076 Issued in AZ
Legal business name
EBONY HOUSE INC
Practice address
6218 S 13TH St
Phoenix, AZ 85042-4408
Phone
(602) 276-4288
Fax
(602) 232-2938
NPI assigned
Dec 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

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

Authorized official

Name
Che Jordan
Title
Ceo
Phone
(602) 276-4288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X BH076 AZ Primary

Addresses

Primary practice location

6218 S 13TH St
Phoenix, AZ 85042-4408

Mailing address

6222 S 13TH St
Phoenix, AZ 85042-4408
Phone (602) 276-4288

Other identifiers 1

IdentifierTypeStateIssuer
319790OtherAZAHCCCS NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Ebony House Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6218 S 13th St
Phoenix, AZ 85042
Phone (602) 276-4288

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690329600000",
    "number": "1023170933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6222 S 13TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850424408",
            "telephone_number": "602-276-4288",
            "fax_number": "602-232-2938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6218 S 13TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850424408",
            "telephone_number": "602-276-4288",
            "fax_number": "602-232-2938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBONY HOUSE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "CHE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-276-4288"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS NUMBER",
            "identifier": "319790",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.