Provider Demographics
NPI:1912888736
Name:ELLEVECROWN LLC
Entity type:Organization
Organization Name:ELLEVECROWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-561-8699
Mailing Address - Street 1:601 PATTON BLVD APT 165
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8929
Mailing Address - Country:US
Mailing Address - Phone:972-561-8699
Mailing Address - Fax:
Practice Address - Street 1:601 PATTON BLVD APT 165
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8929
Practice Address - Country:US
Practice Address - Phone:972-561-8699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier