Organization
ELAINE ELLIS CENTER OF HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN R WALKER (CEO/EXECUTIVE DIRECTOR)
(202) 425-2313
Entity
Organization
Contact information
Practice address
1627 KENILWORTH AVE NE, WASHINGTON, DC 20019-2010
(202) 425-2313
(202) 399-1570
Mailing address
1627 KENILWORTH AVE NE, WASHINGTON, DC 20019-2010
(202) 803-2340
(202) 399-1570
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
09/26/2011
Last updated
11/27/2024
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