Provider Demographics
NPI:1457896714
Name:ELLIS ANGELS HOME CARE, LLC
Entity Type:Organization
Organization Name:ELLIS ANGELS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DURIYYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-374-0132
Mailing Address - Street 1:6714 LOWER MACUNGIE RD
Mailing Address - Street 2:APT K-6
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-9701
Mailing Address - Country:US
Mailing Address - Phone:484-374-0132
Mailing Address - Fax:
Practice Address - Street 1:6714 LOWER MACUNGIE RD
Practice Address - Street 2:APT K-6
Practice Address - City:TREXLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18087-9701
Practice Address - Country:US
Practice Address - Phone:484-374-0132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA32053601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health