Provider Demographics
NPI:1710689443
Name:ELLEBRON LLC
Entity Type:Organization
Organization Name:ELLEBRON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NORBELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-413-5860
Mailing Address - Street 1:978 INDUSTRY DR STE 230
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3400
Mailing Address - Country:US
Mailing Address - Phone:888-413-5860
Mailing Address - Fax:
Practice Address - Street 1:978 INDUSTRY DR STE 230
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3400
Practice Address - Country:US
Practice Address - Phone:888-413-5860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLEBRON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care