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General NPI Number Information
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NPI Number | 1093209272
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Entity Type | Organization
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Legal Business Name | ELLEMSENTERPRISES, LLC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 2202 HIGH BUSH CIR
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City | GLEN ALLEN
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State | VA
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Zip | 23060-2240
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Country | US
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Telephone | 804-640-2101
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Fax | 877-879-6336
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Provider Business Mailing Address
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Address Line | PO BOX 3051
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City | RICHMOND
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State | VA
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Zip | 23228-9701
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Country | US
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Telephone | 804-640-2101
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Fax | 877-879-6336
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MISS LISA MONICA SMITH
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Credential | BS
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Telephone | 804-640-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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