Organization
ITAVIA'S HOUSE OF CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALICIA MICHELLE ELLIS LPC-MHSP, (OWNER/CEO)
(615) 905-6321
Entity
Organization
Contact information
Practice address
10543 CEDAR GROVE RD STE 150, SMYRNA, TN 37167-6525
(615) 905-6321
Mailing address
10543 CEDAR GROVE RD STE 150, SMYRNA, TN 37167-6525
(615) 905-6321
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q034586
—
TN
Enumeration date
06/24/2021
Last updated
06/10/2022
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