Ebenezer House D LLC

Primary specialty

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

Legal business name

EBENEZER HOUSE D LLC

Practice address

2846 W Mila Way
Queen Creek, AZ 85144-6700

Phone

(207) 239-0971

NPI assigned

Aug 3, 2023

Last updated

Aug 3, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

EBENEZER HOUSE D LLCAs reported in NPPES

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

Authorized official

Name

Claudine Kayitesi

Title

Ceo

Phone

(207) 239-0971

Specialties & licenses 1

Addresses

Part of

Ebenezer House D LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Ebenezer House, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, AZ
  • NPI 1891262556
  NPPES parent name

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

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1417639980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2846 W MILA WAY",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851446700",
            "telephone_number": "207-239-0971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2846 W MILA WAY",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851446700",
            "telephone_number": "207-239-0971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HOUSE D LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EBENEZER HOUSE D LLC",
        "enumeration_date": "2023-08-03",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-02",
        "status": "A",
        "authorized_official_last_name": "KAYITESI",
        "authorized_official_first_name": "CLAUDINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-239-0971"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Queen Creek, AZ
• Providers in Queen Creek, 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 Aug 3, 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.