Provider Demographics
NPI:1093292021
Name:ELLSWORTH HEALTHCARE STAFFING LLC
Entity Type:Organization
Organization Name:ELLSWORTH HEALTHCARE STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON-ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-806-8164
Mailing Address - Street 1:160 CLAIREMONT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2546
Mailing Address - Country:US
Mailing Address - Phone:404-806-8164
Mailing Address - Fax:404-369-0404
Practice Address - Street 1:160 CLAIREMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2546
Practice Address - Country:US
Practice Address - Phone:404-806-8164
Practice Address - Fax:404-369-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-1972251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care