Ebenezer House 1 LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

EBENEZER HOUSE 1 LLC

Practice address

35168 N Magnette Way
Queen Creek, AZ 85142-3916

Phone

(602) 609-8966

NPI assigned

Feb 21, 2023

Last updated

Feb 21, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tychiere Agbormah, BHT

Title

Partener

Phone

(480) 740-6688

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676937600000",
    "number": "1144928920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35168 N MAGNETTE WAY",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851423916",
            "telephone_number": "602-609-8966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35168 N MAGNETTE WAY",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851423916",
            "telephone_number": "602-609-8966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HOUSE 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-21",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "AGBORMAH",
        "authorized_official_first_name": "TYCHIERE",
        "authorized_official_title_or_position": "PARTENER",
        "authorized_official_telephone_number": "480-740-6688",
        "authorized_official_credential": "BHT"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.