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General NPI Number Information
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NPI Number | 1255951927
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Entity Type | Organization
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Legal Business Name | ELLIS SENIOR CARE LLC
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 316 E WASHINGTON AVE
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City | VINTON
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State | VA
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Zip | 24179-4516
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Country | US
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Telephone | 540-293-7299
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13704
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City | ROANOKE
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State | VA
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Zip | 24036-3704
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Country | US
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Telephone | 540-293-7299
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | MR. DALE RAY ELLIS
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Credential |
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Telephone | 540-293-8024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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