Provider Demographics
NPI:1932710183
Name:ELAINE ELLIS CENTER OF HEALTH, INC.
Entity type:Organization
Organization Name:ELAINE ELLIS CENTER OF HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-803-2340
Mailing Address - Street 1:1627 KENILWORTH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-2010
Mailing Address - Country:US
Mailing Address - Phone:202-803-2340
Mailing Address - Fax:202-803-2350
Practice Address - Street 1:10001 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1141
Practice Address - Country:US
Practice Address - Phone:301-441-1605
Practice Address - Fax:301-345-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)