MEDICARE: EBONNY HOME HEALTH AGENCY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1003254400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBONNY HOME HEALTH AGENCY INC

Provider Business Mailing Address
First Line	:	1101 N DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1220
Country	:	US
Telephone Number	:	702-399-7154
Fax Number	:	866-528-6506

Provider Business Practice Location Address
First Line	:	1101 N DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1220
Country	:	US
Telephone Number	:	702-399-7154
Fax Number	:	866-528-6506

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MOSES IRUBOR
Credential	:
Telephone Number	:	281-235-3417

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	07/20/2023

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