Provider Demographics
NPI:1851706808
Name:ELLIS MICHAEL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:ELLIS MICHAEL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:KLINGELSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-313-1004
Mailing Address - Street 1:1118 WERTZ AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-2036
Mailing Address - Country:US
Mailing Address - Phone:330-575-3870
Mailing Address - Fax:
Practice Address - Street 1:1118 WERTZ AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-2036
Practice Address - Country:US
Practice Address - Phone:330-575-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-29
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2093478251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health