Healthcare Provider Details

I. General information

NPI: 1255951927
Provider Name (Legal Business Name): ELLIS SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N BLAIR ST
VINTON VA
24179-4501
US

IV. Provider business mailing address

PO BOX 13704
ROANOKE VA
24036-3704
US

V. Phone/Fax

Practice location:
  • Phone: 540-293-7299
  • Fax:
Mailing address:
  • Phone: 540-293-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DALE RAY ELLIS
Title or Position: PRESIDENT/ OWNER
Credential:
Phone: 540-293-8024