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General NPI Number Information
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NPI Number | 1467801134
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Entity Type | Organization
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Legal Business Name | EBONNY BEHAVIORAL CARE SERVICES CORPORATION
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1721 E CHARLESTON BLVD STE 300
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City | LAS VEGAS
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State | NV
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Zip | 89104-1902
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Country | US
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Telephone | 26-850-6207
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Fax | 702-685-9674
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Provider Business Mailing Address
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Address Line | 1721 E CHARLESTON BLVD STE 300
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City | LAS VEGAS
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State | NV
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Zip | 89104-1902
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Country | US
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Telephone | 25-159-6807
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Fax | 702-685-9674
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FESTUS EBONKA
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Credential | APRN
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Telephone | 702-515-9680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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