Provider Demographics
NPI:1750964383
Name:S. ELLIS HOME CARE SERVICES, LLC
Entity type:Organization
Organization Name:S. ELLIS HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-446-3466
Mailing Address - Street 1:2601 BASIN AVE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-5358
Mailing Address - Country:US
Mailing Address - Phone:334-446-3466
Mailing Address - Fax:888-273-6606
Practice Address - Street 1:2601 BASIN AVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-5358
Practice Address - Country:US
Practice Address - Phone:334-446-3466
Practice Address - Fax:888-273-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health