| Ebonny Behavioral Care Services Corporation | |
|
1721 E Charleston Blvd Las Vegas NV 89104-1902 | |
| (702) 515-9680 | |
| (702) 685-9674 |
| Full Name | Ebonny Behavioral Care Services Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 1721 E Charleston Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Festus Ebonka (PRESIDENT) |
| Authorized Official Contact | 7025159680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebonny Behavioral Care Services Corporation 1721 E Charleston Blvd Las Vegas NV 89104-1902 Ph: (702) 515-9680 | Ebonny Behavioral Care Services Corporation 1721 E Charleston Blvd Las Vegas NV 89104-1902 Ph: (702) 515-9680 |
| NPI Number | 1467801134 |
|---|---|
| Provider Enumeration Date | 06/03/2016 |
| Last Update Date | 11/15/2016 |
| Medicare PECOS PAC ID | 5799067955 |
|---|---|
| Medicare Enrollment ID | O20170123002742 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467801134 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Bernard K Addo Quaye |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922009208 PECOS PAC ID: 2860470036 Enrollment ID: I20060206000797 |
| Provider Name | Festus O Ebonka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932241007 PECOS PAC ID: 3971609512 Enrollment ID: I20150513000946 |
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