MEDICARE: CASSANDRA ELLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	326741	NY

General Provider Information

NPI Number	:	1861942989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASSANDRA ELLIS

Provider Business Mailing Address
First Line	:	1816 EDISON AVE APT 2C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-4194
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 EDISON AVE APT 2C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-4194
Country	:	US
Telephone Number	:	914-314-8182
Fax Number	:

Authorized Official
Title or Position	:	LPN
Name	:	MS. CASSANDRA ELLIS
Credential	:
Telephone Number	:	914-314-8182

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/13/2016

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