Provider Demographics
NPI:1811588346
Name:ELLIE HOUSE INC
Entity Type:Organization
Organization Name:ELLIE HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:OSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-539-9700
Mailing Address - Street 1:106 E MARKET ST STE 301
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-1151
Mailing Address - Country:US
Mailing Address - Phone:330-539-9700
Mailing Address - Fax:330-539-9708
Practice Address - Street 1:106 E MARKET ST STE 301
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1151
Practice Address - Country:US
Practice Address - Phone:330-539-9700
Practice Address - Fax:330-539-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5005950Medicaid