Provider Demographics
NPI:1992032213
Name:EBONY GROUP INCORPORATED
Entity Type:Organization
Organization Name:EBONY GROUP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:UMUNNA
Authorized Official - Last Name:EBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-221-9929
Mailing Address - Street 1:522 W 127TH ST STE 313
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-7002
Mailing Address - Country:US
Mailing Address - Phone:323-418-1620
Mailing Address - Fax:323-418-1620
Practice Address - Street 1:522 W 127TH ST STE 313
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-7002
Practice Address - Country:US
Practice Address - Phone:323-418-1620
Practice Address - Fax:323-418-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3191112251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management