{
"Npi": {
"NPI": "1578429726",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EBI HEALTHCARE SERVICES LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "145 FREEDOM WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SICKLERVILLE",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08081-5725",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "856-796-3303",
"MailingAddressFaxNumber": "866-993-2928",
"FirstLinePracticeLocationAddress": "103 ROUTE 70 E STE 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARLTON",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08053-1890",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "856-796-3303",
"PracticeLocationAddressFaxNumber": "866-993-2928",
"EnumerationDate": "12/31/2025",
"LastUpdateDate": "12/31/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EBISIKE",
"AuthorizedOfficialFirstName": "UZOMA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "856-796-3303",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}