Provider Demographics
NPI:1003254400
Name:EBONNY HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:EBONNY HOME HEALTH AGENCY INC
Other - Org Name:EBONNY HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:IRUBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-235-3417
Mailing Address - Street 1:1101 N DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-1220
Mailing Address - Country:US
Mailing Address - Phone:702-399-7154
Mailing Address - Fax:866-528-6506
Practice Address - Street 1:1101 N DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-1220
Practice Address - Country:US
Practice Address - Phone:702-399-7154
Practice Address - Fax:866-528-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health