Organization
ELLISON COMMUNITY RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TEKESHA A ELLISON (PRESIDENT, CEO)
(904) 572-5294
Entity
Organization
Contact information
Practice address
4688 CAMP CREEK LN, ORANGE PARK, FL 32065-2666
(904) 572-5294
Mailing address
4688 CAMP CREEK LN, ORANGE PARK, FL 32065-2666
(904) 572-5294
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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