Individual
MRS. ETHEL BOGAN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 KINGSTON DRIVE, WHARTON, TX 77488-5708
(979) 532-3720
(979) 532-3720
Mailing address
1110 KINGSTON DR, WHARTON, TX 77488-5708
(979) 532-3720
(979) 532-3720
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/12/2007
Last updated
07/12/2007
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