Beverly Diane Ellis

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

BEVERLY DIANE ELLIS

Practice address

420 Tierney Rd
Fort Worth, TX 76112-6324

Phone

(817) 534-5480

Fax

(817) 534-4748

NPI assigned

Jan 8, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Beverly Ellis

Title

Ceo

Phone

(817) 534-5480

Specialties & licenses 2

Addresses

Tax ID family

Beverly Diane Ellis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Beverly Ellis HCS Inc

  • Point of Service
  • Fort Worth, TX
  • NPI 1164708533
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1639316912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 TIERNEY RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761126324",
            "telephone_number": "817-534-5480",
            "fax_number": "817-534-4748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 TIERNEY RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761126324",
            "telephone_number": "817-534-5480",
            "fax_number": "817-534-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY DIANE ELLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-08",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-534-5480"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irma Elena Betty, M.D.
• Garrett Beutel
• Catherine Irene Bevan, MD
• Taylor Bevan, F.N.P.
• Zachary Dean Bevans, ATP
• Beverly Ellis HCS Inc
• Beverly Hills Pain Management
• Esda Beverly, LPC
• Kelly Beverly
• Alexandra Lee Bewley, PA-C

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.