Provider Demographics
NPI:1275830184
Name:HILL, EBONY CHARISSE
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:CHARISSE
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MILL ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2259
Mailing Address - Country:US
Mailing Address - Phone:775-348-8048
Mailing Address - Fax:775-848-8048
Practice Address - Street 1:3100 MILL ST
Practice Address - Street 2:SUITE 206
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2259
Practice Address - Country:US
Practice Address - Phone:775-348-8048
Practice Address - Fax:775-848-8048
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511515Medicaid