| Ebenezer House 1llc | |
|
35168 N Magnette Way Queen Creek AZ 85142-3916 | |
| (407) 236-6552 | |
| Not Available |
| Full Name | Ebenezer House 1llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 35168 N Magnette Way, Queen Creek, Arizona |
| Authorized Official Name and Position | Ossie Torgrimson (CHIEF OFFICER FINANICAL) |
| Authorized Official Contact | 4072366552 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebenezer House 1llc 35168 N Magnette Way Queen Creek AZ 85142-3916 Ph: (407) 236-6552 | Ebenezer House 1llc 35168 N Magnette Way Queen Creek AZ 85142-3916 Ph: (407) 236-6552 |
| NPI Number | 1740910348 |
|---|---|
| Provider Enumeration Date | 06/15/2022 |
| Last Update Date | 06/15/2022 |
| Certification Date | 06/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740910348 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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