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General NPI Number Information
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NPI Number | 1578479077
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Entity Type | Individual
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Provider Name | CALEB Z ELLIS PRS
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Gender | Male
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 1724 S 3RD ST
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City | IRONTON
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State | OH
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Zip | 45638-2269
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Country | US
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Telephone | 740-442-7143
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Fax |
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Provider Business Mailing Address
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Address Line | 102 SOLIDA RD
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City | SOUTH POINT
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State | OH
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Zip | 45680-8423
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Country | US
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Telephone | 740-523-0043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | PRS.008281
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License Number State | OH
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