Individual provider · Type 1 NPI
Ethel Bogan Ellis
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Wharton, TX
Practice location
1110 Kingston Drive
Wharton, TX 77488-5708
Fax (979) 532-3720
Mailing address
1110 Kingston Dr
Wharton, TX 77488-5708
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | None listed |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
About NPI 1780883553
Ethel Bogan Ellis's National Provider Identifier is 1780883553, issued on Jul 12, 2007. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Wharton, TX. The record was last updated on Jul 12, 2007.