Organization
ELLISON'S FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CLARISSA BROADNAX ELLISON (ADMINISTRATOR)
(336) 349-2220
Entity
Organization
Contact information
Practice address
372 CANDY CREEK RD, REIDSVILLE, NC 27320-1626
(336) 349-2220
(336) 349-2273
Mailing address
372 CANDY CREEK RD, REIDSVILLE, NC 27320-1626
(336) 349-2220
(336) 349-2273
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCL-079-004
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7801455
—
NC
Enumeration date
12/04/2007
Last updated
12/04/2007
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