Provider Demographics
NPI:1801318894
Name:ELLISON HOME CARE COMPANION AGENCY LLC
Entity type:Organization
Organization Name:ELLISON HOME CARE COMPANION AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE
Authorized Official - Phone:631-885-4986
Mailing Address - Street 1:147 W ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-8109
Mailing Address - Country:US
Mailing Address - Phone:631-885-4986
Mailing Address - Fax:631-513-4699
Practice Address - Street 1:2851 SW 142ND LN
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-2575
Practice Address - Country:US
Practice Address - Phone:352-615-7820
Practice Address - Fax:631-513-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234910376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty