Organization
EBONY HOUSE INC
Active
Other names
Elba House
Organization subpart
No
Provider details
NPI number
Authorized official
CHE JORDAN (CEO)
(602) 276-4288
Entity
Organization
Contact information
Practice address
8646 S 14TH ST, PHOENIX, AZ 85042-7902
(602) 243-5491
(602) 243-5486
Mailing address
6222 S 13TH ST, PHOENIX, AZ 85042-4408
(602) 276-4288
(602) 232-2938
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH2371
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
845604
AHCCCS NUMBER
AZ
Enumeration date
12/19/2006
Last updated
07/26/2023
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