EBENEZER HOUSE I , LLC
NPI 1407426273
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Phoenix, AZ

Active since June 24, 2021
4055 N 77TH DR, PHOENIX, AZ 85033(623) 440-4404(623) 777-0082 Get Directions Write a Review

NPPES record last updated: June 24, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ebenezer House I , Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBENEZER HOUSE I , LLC (NPI 1407426273), doing business as Ebenezer House I, is a healthcare organization registered as a residential treatment facility, intellectual and/or developmental disabilities in Phoenix, Arizona and active in the NPI registry since June 2021. The organization lists Eric Nibizi, Ceo, as its authorized official.

NPPES Registry Identity

NPI1407426273
Entity TypeOrganization
Primary Taxonomy320600000X
Legal Business NameEBENEZER HOUSE I , LLC
Location Address4055 N 77TH DRPhoenix, AZ 85033-3618
Mailing Address11114 W College DrPhoenix, AZ 85037-1269 · (623) 440-4404
Fax(623) 777-0082
Organization SubpartNo
Authorized OfficialEric NibiziCeo · (623) 440-4404
Enumeration DateJune 24, 2021
NPPES CertifiedJune 24, 2021
NPI 1407426273 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320600000X
Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

4055 N 77TH DR, Phoenix, AZ 85033

Other Names 1

Doing Business AsEbenezer House I

Other Identifiers 1

Medicaid0000AZ

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Community Based Residential Treatment Facility, Mental Illness
4055 N 77TH DR
PHOENIX, AZ 85033

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebenezer House I , LLC's NPI number?

The NPI number for Ebenezer House I , LLC is 1407426273. It was assigned to this organization in the NPPES registry on June 24, 2021. The provider is doing business as Ebenezer House I.

Where is Ebenezer House I , LLC located?

Ebenezer House I , LLC is located at 4055 N 77th Dr, Phoenix, AZ 85033. The listed phone number is (623) 440-4404.

What is Ebenezer House I , LLC's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.

When was this NPI record last updated?

The NPPES record for Ebenezer House I , LLC was last updated on June 24, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.