Beverly Diane Ellis
Beverly Diane Ellis is an Intellectual and/or Developmental Disabilities Residential Treatment Facility in Fort Worth, Texas. Registered with an NPI since 2009.
- In the registry since
- 2009
- Specialties on file
- 2
Practice location Address checks out
420 Tierney RdFort Worth, TX 76112-6324
Phone: (817) 534-5480
Fax: (817) 534-4748
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Specialties & licences
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary) | Taxonomy 320900000X |
|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | Taxonomy 320600000X |
Record details
| NPI number | 1639316912 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Beverly Ellis — Ceo · (817) 534-5480 |
| NPI enumerated | January 8, 2009 |
| Last updated in NPPES | January 8, 2009 |
| Mailing address | 420 Tierney Rd, Fort Worth, TX 76112-6324 |
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