NPI 1932346210

Eddie Ellis Junior Hcs

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Fort Worth, TX

Practice location

Address: 420 Tierney Rd, Fort Worth, TX 76112-6324
Phone: (817) 534-5480
Fax: (817) 534-4748

Authorised official

Name: Eddie Ellis
Title: Ceo
Phone: (817) 534-5480

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X

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Registry record

NPI: 1932346210
Entity type: Organization
NPI issued: 8 Jan 2009
Record last updated: 8 Jan 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.