Organization
ELAINE ELLIS CENTER OF HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN R WALKER (CEO)
(301) 441-1605
Entity
Organization
Contact information
Practice address
10001 RHODE ISLAND AVE, COLLEGE PARK, MD 20740-1141
(301) 441-1605
(301) 345-1609
Mailing address
10001 RHODE ISLAND AVE, COLLEGE PARK, MD 20740-1141
(301) 441-1605
(301) 345-1609
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
400312000595
DC
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
082390200
—
DC
05
—
500072600
—
MD
Enumeration date
02/25/2017
Last updated
03/01/2017
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