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General NPI Number Information
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NPI Number | 1164720371
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Entity Type | Organization
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Legal Business Name | NELLIS ADULT DAYCARE LLC
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 1902 VIRGINIA AVE
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2834
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Country | US
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Telephone | 765-692-0260
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Fax | 765-692-0261
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Provider Business Mailing Address
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Address Line | 1902 VIRGINIA AVE
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2834
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Country | US
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Telephone | 765-692-0260
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Fax | 765-692-0261
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Authorized Official
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Title or Position | EXECTUTIVE DIRECTOR
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Name | MRS. SUZANNE CAROL ELLIS
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Credential | RN
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Telephone | 765-692-0260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 201008180A
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License Number State | IN
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