Provider Demographics
NPI:1093480725
Name:EBONY BEHAVIORAL INC.
Entity Type:Organization
Organization Name:EBONY BEHAVIORAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-407-7370
Mailing Address - Street 1:14201 FM 1761
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-4771
Mailing Address - Country:US
Mailing Address - Phone:956-407-7370
Mailing Address - Fax:
Practice Address - Street 1:14201 FM 1761
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4771
Practice Address - Country:US
Practice Address - Phone:956-407-7370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness