Provider Demographics
NPI:1164832838
Name:ELLIS PREPARATORY ACADEMY INC
Entity Type:Organization
Organization Name:ELLIS PREPARATORY ACADEMY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-760-2340
Mailing Address - Street 1:200 BOOTH RD STE C
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5716
Mailing Address - Country:US
Mailing Address - Phone:386-872-5017
Mailing Address - Fax:
Practice Address - Street 1:200 BOOTH RD STE C
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5716
Practice Address - Country:US
Practice Address - Phone:386-872-5017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)