Beverly Diane Ellis

LBN: Beverly Diane Ellis
Beverly Diane Ellis is an health care organization with primary practice located at 420 Tierney Rd , Fort Worth TX 76112-6324. The organization recently has 2 registered licenses in different health care specialties including Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities. Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities is the primary health care specialty. Beverly Diane Ellis can be contacted via phone (817) 534-5480, or through Ellis, Beverly via phone (817) 534-5480.

Contact Information

Primary practice address
420 Tierney Rd Fort Worth TX 76112-6324
Phone: (817) 534-5480
Fax: (817) 534-4748
Website:
Map and Directions
Authorized official contact:
Name: Ellis, Beverly
Phone: (817) 534-5480

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X

Profile Details

NPI number 1639316912
LBN Legal business name Beverly Diane Ellis
DBA Doing business as
Authorized official Ellis, Beverly
Entity Organization
Organization subpart 1 No
Enumeration date Jan 8th, 2009
Last updated Jan 8th, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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