Organization
EBENEZER HOUSE 1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYCHIERE AGBORMAH BHT (PARTENER)
(480) 740-6688
Entity
Organization
Contact information
Practice address
35168 N MAGNETTE WAY, QUEEN CREEK, AZ 85142-3916
(602) 609-8966
Mailing address
35168 N MAGNETTE WAY, QUEEN CREEK, AZ 85142-3916
(602) 609-8966
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/21/2023
Last updated
02/21/2023
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