Ebenezer House 1 LLC
NPI #1144928920 in Queen Creek, Arizona
Provider Information
- NPI Number
- 1144928920
- Entity Type
- Organization
- Organization Name
- Ebenezer House 1 LLC
- Primary Specialty
- Community Based Residential Treatment Facility, Mental Illness
- Enumeration Date
- Feb 21, 2023
- Last Updated
- Feb 21, 2023
Practice Location
- Address
- 35168 N MAGNETTE WAY
- City
- Queen Creek
- State
- Arizona
- ZIP Code
- 85142-3916
- Phone
- (602) 609-8966
Authorized Official
- Name
- TYCHIERE AGBORMAH, BHT
- Title
- PARTENER
- Phone
- (480) 740-6688
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Mental Illness |
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