Active NPI
Chasity Ellis
- In Home Supportive Care Agency
- Winder, GA
National Provider Identifier
1336941590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- In Home Supportive Care Agency
- Practice address
- 1272 Wentworth Cove CT
Winder, GA 30680-5218 - Phone
- (404) 710-4397
- NPI assigned
- Mar 26, 2025
- Last updated
- Mar 26, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | NU | ||
| In Home Supportive Care Agency | 253Z00000X | NU | Primary | |
| Meals Provider | 174200000X | NU |
Addresses
Primary practice location
1272 Wentworth Cove CT
Winder, GA 30680-5218
Mailing address
1272 Wentworth Cove CT
Winder, GA 30680-5218
Phone (404) 710-4397
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742947200000",
"number": "1336941590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1272 WENTWORTH COVE CT",
"city": "WINDER",
"state": "GA",
"postal_code": "306805218",
"telephone_number": "404-710-4397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1272 WENTWORTH COVE CT",
"city": "WINDER",
"state": "GA",
"postal_code": "306805218",
"telephone_number": "404-710-4397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "CHASITY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-03-26",
"last_updated": "2025-03-26",
"certification_date": "2025-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "174200000X",
"taxonomy_group": "",
"desc": "Meals",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Winder, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.