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General NPI Number Information
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NPI Number | 1063073203
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Entity Type | Organization
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Legal Business Name | EBONY HOUSE INC
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 1616 E INDIAN SCHOOL RD STE 415
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City | PHOENIX
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State | AZ
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Zip | 85016-8604
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Country | US
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Telephone | 602-281-6165
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Fax | 602-281-6522
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Provider Business Mailing Address
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Address Line | 6222 S 13TH ST
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City | PHOENIX
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State | AZ
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Zip | 85042-4408
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Country | US
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Telephone | 602-276-4288
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHE JORDAN
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Credential |
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Telephone | 602-276-4288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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