Provider Demographics
NPI:1316809601
Name:PHILLIPS, ELLEN RUTH
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:RUTH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7965 COUNTY ROAD 107 LOT 2B
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-8042
Mailing Address - Country:US
Mailing Address - Phone:740-744-0626
Mailing Address - Fax:
Practice Address - Street 1:7965 COUNTY ROAD 107 LOT 2B
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8042
Practice Address - Country:US
Practice Address - Phone:740-744-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant