Provider Demographics
NPI:1508010133
Name:ELLIS CARE SERVICES INC.
Entity Type:Organization
Organization Name:ELLIS CARE SERVICES INC.
Other - Org Name:ELLIS OUTREACH MINISTRIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO / CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-926-9148
Mailing Address - Street 1:5801 STAHELIN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-4736
Mailing Address - Country:US
Mailing Address - Phone:313-926-9148
Mailing Address - Fax:313-633-9135
Practice Address - Street 1:5801 STAHELIN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-4736
Practice Address - Country:US
Practice Address - Phone:313-926-9148
Practice Address - Fax:313-633-9135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-10
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7629513Medicaid