Ebenezer House 1LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

EBENEZER HOUSE 1LLC

Practice address

35168 N Magnette Way
Queen Creek, AZ 85142-3916

Phone

(407) 236-6552

NPI assigned

Jun 15, 2022

Organization subpart

No

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

Authorized official

Name

Ossie Torgrimson

Title

Chief Officer Finanical

Phone

(407) 236-6552

Specialties & licenses 1

Addresses

Other names 1

• EBENEZER HOUSE Doing business as

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655251200000",
    "number": "1740910348",
    "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": "407-236-6552"
        },
        {
            "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": "407-236-6552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HOUSE 1LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-15",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A",
        "authorized_official_last_name": "TORGRIMSON",
        "authorized_official_first_name": "OSSIE",
        "authorized_official_title_or_position": "CHIEF OFFICER  FINANICAL",
        "authorized_official_telephone_number": "407-236-6552"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EBENEZER HOUSE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Joshua Eberhard, D.O.
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• Justin Ehmke, PA-C
• Candee J. Eisenhart, NP

• All providers in Queen Creek, AZ
• Community/Behavioral Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; 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.