Provider Demographics
NPI:1164708533
Name:BEVERLY ELLIS HCS INC
Entity Type:Organization
Organization Name:BEVERLY ELLIS HCS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-534-5480
Mailing Address - Street 1:2320 BLUE SMOKE CT N
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-1003
Mailing Address - Country:US
Mailing Address - Phone:817-534-5480
Mailing Address - Fax:817-534-4748
Practice Address - Street 1:2320 BLUE SMOKE CT N
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-1003
Practice Address - Country:US
Practice Address - Phone:817-534-5480
Practice Address - Fax:817-534-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service