Healthcare Provider Details

I. General information

NPI: 1649279845
Provider Name (Legal Business Name): ELLIS HOME HEALTH SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W MAIN ST
ABINGDON VA
24210-2715
US

IV. Provider business mailing address

211 W MAIN ST
ABINGDON VA
24210-2715
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-2901
  • Fax: 276-628-4526
Mailing address:
  • Phone: 276-628-8181
  • Fax: 276-628-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0206008402
License Number StateVA

VIII. Authorized Official

Name: MR. H. DOUGLAS ELLIS
Title or Position: PRESIDENT
Credential:
Phone: 276-628-8181