Provider Demographics
NPI:1023397205
Name:S. ELLIS HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:S. ELLIS HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-679-5714
Mailing Address - Street 1:PO BOX 81314
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-9314
Mailing Address - Country:US
Mailing Address - Phone:770-679-5714
Mailing Address - Fax:888-273-6606
Practice Address - Street 1:1233 SALEM GATE DRIVE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1362
Practice Address - Country:US
Practice Address - Phone:770-679-5714
Practice Address - Fax:888-273-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122-R-0901251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health