Organization
EBENEZER HOUSE D LLC
Active
Parent organization
EBENEZER HOUSE D LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EBENEZER HOUSE D LLC
Authorized official
CLAUDINE KAYITESI (CEO)
(207) 239-0971
Entity
Organization
Contact information
Practice address
2846 W MILA WAY, QUEEN CREEK, AZ 85144-6700
(207) 239-0971
Mailing address
2846 W MILA WAY, QUEEN CREEK, AZ 85144-6700
(207) 239-0971
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/03/2023
Last updated
08/03/2023
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