Ebenezer House I , LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

EBENEZER HOUSE I , LLC

Practice address

4055 N 77TH Dr
Phoenix, AZ 85033-3618

Phone

(623) 440-4404

Fax

(623) 777-0082

NPI assigned

Jun 24, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Eric Nibizi

Title

Ceo

Phone

(623) 440-4404

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• EBENEZER HOUSE I Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1407426273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11114 W COLLEGE DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850371269",
            "telephone_number": "623-440-4404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 N 77TH DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850333618",
            "telephone_number": "623-440-4404",
            "fax_number": "623-777-0082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HOUSE I , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "NIBIZI",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "623-440-4404",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "INTERNET",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4055 N 77th Dr",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850333618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "EBENEZER HOUSE I",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kingsley Ebare, MD
• Rebecca Ebbert
• Brittany Gabrielle Ebbing, MD, MPH
• Lawrence Ebel, DMD
• Ebenezer Behavioral Care, LLC
• Ebenezer House, LLC
• Fidelis Osondu Ebereonwu
• Renee S Eberhardt, LMT
• Marian C Eberly, RN, LCSW
• Lance Eberson, MD

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; 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.