| NPI | 1891262556 |
|---|---|
| Former Legal Business Name | EBENEZER HOUSE |
| Entity Type | Organization |
| Authorized Contact | NIGEL SANTIAGO Chief Executive Officer 602-686-3318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2018-10-30 |