Provider Demographics
NPI:1245240365
Name:ELLIS REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:ELLIS REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-675-0000
Mailing Address - Street 1:115 S MURCHISON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-2662
Mailing Address - Country:US
Mailing Address - Phone:903-675-0000
Mailing Address - Fax:903-675-5520
Practice Address - Street 1:5609 DONNYBROOK AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6111
Practice Address - Country:US
Practice Address - Phone:903-561-2808
Practice Address - Fax:903-939-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0094BGOtherBCBS
TX110019002Medicaid
TX122300OtherCHIPS
TX110019004Medicaid
TX110019004Medicaid