Organization
NELLIS ADULT DAYCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZANNE CAROL ELLIS RN (EXECTUTIVE DIRECTOR)
(765) 692-0260
Entity
Organization
Contact information
Practice address
1902 VIRGINIA AVE, CONNERSVILLE, IN 47331-2834
(765) 692-0260
(765) 692-0261
Mailing address
1902 VIRGINIA AVE, CONNERSVILLE, IN 47331-2834
(765) 692-0260
(765) 692-0261
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
201008180A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201008180A
—
IN
Enumeration date
03/11/2011
Last updated
03/11/2011
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