NPIMap

Organization Active NPI

Ebonny Behavioral Care Services Corporation

  • Primary Care Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1467801134
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
EBONNY BEHAVIORAL CARE SERVICES CORPORATION
Practice address
1721 E Charleston Blvd Ste 300
Las Vegas, NV 89104-1902
Phone
(026) 850-6207
Fax
(702) 685-9674
NPI assigned
Jun 3, 2016
Last updated
Apr 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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

Authorized official

Name
Mr. Festus Ebonka, APRNNPI 1932241007
Title
President
Phone
(702) 515-9680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X
Primary Care Clinic/Center 261QP2300X Primary
Family Nurse Practitioner 363LF0000X
Primary Care Nurse Practitioner 363LP2300X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

1721 E Charleston Blvd Ste 300
Las Vegas, NV 89104-1902

Mailing address

1721 E Charleston Blvd Ste 300
Las Vegas, NV 89104-1902
Phone (025) 159-6807

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170123002742 NV Part B Supplier - Clinic/Group Practice 5799067955 Receives reassigned benefits from 2 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

1721 E Charleston Blvd
Ste 300
Las Vegas, NV 89104

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1467801134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 E CHARLESTON BLVD STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041902",
            "telephone_number": "025-159-6807",
            "fax_number": "702-685-9674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 E CHARLESTON BLVD STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041902",
            "telephone_number": "026-850-6207",
            "fax_number": "702-685-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBONNY BEHAVIORAL CARE SERVICES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-03",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A",
        "authorized_official_last_name": "EBONKA",
        "authorized_official_first_name": "FESTUS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-515-9680",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.