Healthcare Provider Details

I. General information

NPI: 1639425341
Provider Name (Legal Business Name): MACY NEIL ELLINGTON CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MACY NEIL ELLINGON CADC II

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 N CHESTER AVE
BAKERSFIELD CA
93308-1770
US

IV. Provider business mailing address

PO BOX 315
BAKERSFIELD CA
93302-0315
US

V. Phone/Fax

Practice location:
  • Phone: 661-428-0333
  • Fax:
Mailing address:
  • Phone: 661-428-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberA021500116
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberA021500116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: