Individual
MR. JIMMY LEE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 N LINKS DR APT 1061, AVONDALE, AZ 85323-3046
(480) 487-8480
Mailing address
3420 E SHEA BLVD STE 204, PHOENIX, AZ 85028-3345
(480) 487-8480
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
12/03/2018
Last updated
01/05/2019
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