Organization
EBENEZER HOUSE I , LLC
Active
Other names
EBENEZER HOUSE I
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC NIBIZI (CEO)
(623) 440-4404
Entity
Organization
Contact information
Practice address
4055 N 77TH DR, PHOENIX, AZ 85033-3618
(623) 440-4404
(623) 777-0082
Mailing address
11114 W COLLEGE DR, PHOENIX, AZ 85037-1269
(623) 440-4404
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000
—
AZ
Enumeration date
06/24/2021
Last updated
06/24/2021
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