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Mrs. Ethel Bogan Ellis
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Wharton, Texas
NPI 1780883553

Ethel Bogan Ellis is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Wharton, TX. Ethel Bogan Ellis practices in Wharton, TX. The NPI Number for Ethel Bogan Ellis is 1780883553 and holds a License No. (Texas).

The current practice location address for Ethel Bogan Ellis is 1110 Kingston Drive, Wharton, TX and can be reached out via phone at 979-532-3720 and via fax at 979-532-3720.

Location: 1110 Kingston Drive, Wharton, TX, 77488-5708
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1780883553
Provider Name
Ethel Bogan Ellis
Credential
Provider Entity Type
Individual
Gender
Female
Address
1110 Kingston Drive, Wharton, TX, 77488-5708
Phone Number
979-532-3720
Fax Number
979-532-3720
Provider Enumeration Date
07/12/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1110 Kingston Drive
City
Wharton
State
Texas
Zip
77488-5708
Phone Number
979-532-3720
Fax Number
979-532-3720
person
Provider Business Mailing Address Details
Address
1110 Kingston Drive
City
Wharton
State
Texas
Zip
77488-5708
Phone Number
979-532-3720
Fax Number
979-532-3720
person
Provider's Taxonomy Details 1
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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