MEDICARE: ELLIS CONSULTING AND ASSOCIATES

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	323P00000X	Psychiatric Residential Treatment Facility	MHL-063-085	NC

General Provider Information

NPI Number	:	1982935284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIS CONSULTING AND ASSOCIATES

Provider Business Mailing Address
First Line	:	4989 ROCKFISH RD
Second Line	:
City	:	RAEFORD
State	:	NC
Zip	:	28376-8355
Country	:	US
Telephone Number	:	910-848-0023
Fax Number	:	910-848-0026

Provider Business Practice Location Address
First Line	:	778 HOFFMAN ROAD
Second Line	:
City	:	JACKSON SPRINGS
State	:	NC
Zip	:	27281
Country	:	US
Telephone Number	:	910-848-0023
Fax Number	:	910-848-0026

Authorized Official
Title or Position	:	CEO
Name	:	DR. DUKE E ELLIS II
Credential	:
Telephone Number	:	910-286-1991

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	01/26/2010

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