Organization
ELLIS FAMILY ID SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA K. ELLIS (OWNER/TREASURE)
(865) 724-6748
Entity
Organization
Contact information
Practice address
3925 POPLAR GROVE RD, MARYVILLE, TN 37804-4701
(865) 724-7208
Mailing address
3925 POPLAR GROVE RD, MARYVILLE, TN 37804-4701
(865) 724-7208
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/01/2023
Last updated
04/16/2025
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