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Organization

EBENEZER HOUSE, LLC

Active
Other names
Ebenezer House
Organization subpart
No

Provider details

NPI number
Authorized official
NIGEL SANTIAGO (CHIEF EXECUTIVE OFFICER)
(602) 686-3318
Entity
Organization

Contact information

Practice address
4055 N 77TH DR, PHOENIX, AZ 85033-3618
(602) 686-3318
Mailing address
1364 N CONSTELLATION WAY, GILBERT, AZ 85234-1458
(602) 686-3318

Taxonomy

Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary

Other

Enumeration date
10/30/2018
Last updated
10/30/2018
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