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General NPI Number Information
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NPI Number | 1427331461
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Entity Type | Organization
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Legal Business Name | ELAINE ELLIS CENTER OF HEALTH, INC.
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1627 KENILWORTH AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-2010
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Country | US
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Telephone | 202-425-2313
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Fax | 202-399-1570
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Provider Business Mailing Address
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Address Line | 1627 KENILWORTH AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-2010
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Country | US
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Telephone | 202-803-2340
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Fax | 202-399-1570
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | JACQUELYN R WALKER
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Credential |
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Telephone | 202-425-2313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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