Provider Demographics
NPI:1053777300
Name:ELLISON HOME CARE COMPANION AGENCY, INC.
Entity type:Organization
Organization Name:ELLISON HOME CARE COMPANION AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-576-4060
Mailing Address - Street 1:1747 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 44
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1534
Mailing Address - Country:US
Mailing Address - Phone:631-576-4060
Mailing Address - Fax:631-513-4699
Practice Address - Street 1:1747 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 44
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1534
Practice Address - Country:US
Practice Address - Phone:631-576-4060
Practice Address - Fax:631-513-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-01
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2254-L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health