Ebenezer House, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

EBENEZER HOUSE, LLC

Practice address

4055 N 77TH Dr
Phoenix, AZ 85033-3618

Phone

(602) 686-3318

NPI assigned

Oct 30, 2018

Organization subpart

No

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

Authorized official

Name

Nigel Santiago

Title

Chief Executive Officer

Phone

(602) 686-3318

Specialties & licenses 1

Addresses

Other names 1

• Ebenezer House Former legal business name

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Ebenezer House D LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Queen Creek, AZ
  • NPI 1417639980
  NPPES parent name

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540857600000",
    "number": "1891262556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1364 N CONSTELLATION WAY",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852341458",
            "telephone_number": "602-686-3318"
        },
        {
            "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": "602-686-3318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-30",
        "last_updated": "2018-10-30",
        "status": "A",
        "authorized_official_last_name": "SANTIAGO",
        "authorized_official_first_name": "NIGEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "602-686-3318"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ebenezer House",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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

• Mental Illness Community Based Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, 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 Oct 30, 2018; 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.