Provider Demographics
NPI:1124263520
Name:THE ELLISON NURSING GROUP, LLC
Entity type:Organization
Organization Name:THE ELLISON NURSING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:267-513-1722
Mailing Address - Street 1:500 OFFICE CENTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3219
Mailing Address - Country:US
Mailing Address - Phone:267-513-1722
Mailing Address - Fax:267-513-1728
Practice Address - Street 1:500 OFFICE CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3219
Practice Address - Country:US
Practice Address - Phone:267-513-1722
Practice Address - Fax:267-513-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-13
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN232274L163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty