Provider Demographics
NPI:1255951927
Name:ELLIS SENIOR CARE LLC
Entity type:Organization
Organization Name:ELLIS SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-293-8024
Mailing Address - Street 1:PO BOX 13704
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24036-3704
Mailing Address - Country:US
Mailing Address - Phone:540-293-7299
Mailing Address - Fax:
Practice Address - Street 1:316 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-4516
Practice Address - Country:US
Practice Address - Phone:540-293-7299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health