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Beverly Diane Ellis
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Fort Worth, Texas
NPI 1639316912

Beverly Diane Ellis is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Fort Worth, TX. Beverly Diane Ellis practices in Fort Worth, TX. The NPI Number for Beverly Diane Ellis is 1639316912 and holds a License No. (Texas).

The current practice location address for Beverly Diane Ellis is 420 Tierney Rd, Fort Worth, TX and can be reached out via phone at 817-534-5480 and via fax at 817-534-4748.

Location: 420 Tierney Rd, Fort Worth, TX, 76112-6324
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1639316912
Provider Name
Beverly Diane Ellis
Credential
Provider Entity Type
Organization
Address
420 Tierney Rd, Fort Worth, TX, 76112-6324
Phone Number
817-534-5480
Fax Number
817-534-4748
Provider Enumeration Date
01/08/2009
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
420 Tierney Rd
City
Fort Worth
State
Texas
Zip
76112-6324
Phone Number
817-534-5480
Fax Number
817-534-4748
person
Provider Business Mailing Address Details
Address
420 Tierney Rd
City
Fort Worth
State
Texas
Zip
76112-6324
Phone Number
817-534-5480
Fax Number
817-534-4748
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320600000X
License No.
()
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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