Provider Demographics
NPI:1982935284
Name:ELLIS CONSULTING AND ASSOCIATES
Entity Type:Organization
Organization Name:ELLIS CONSULTING AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DUKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:910-286-1991
Mailing Address - Street 1:4989 ROCKFISH RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8355
Mailing Address - Country:US
Mailing Address - Phone:910-848-0023
Mailing Address - Fax:910-848-0026
Practice Address - Street 1:778 HOFFMAN ROAD
Practice Address - Street 2:
Practice Address - City:JACKSON SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27281
Practice Address - Country:US
Practice Address - Phone:910-848-0023
Practice Address - Fax:910-848-0026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSROADS HEALTHCARE ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-063-085323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility