Terrell Tyray Ellis

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Practice address

21408 Inkster Rd
Southfield, MI 48033-5026

Phone

(947) 224-0379

Fax

(947) 941-2603

NPI assigned

Sep 16, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1790455152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21408 INKSTER RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480335026",
            "telephone_number": "949-472-2403",
            "fax_number": "947-941-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21408 INKSTER RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480335026",
            "telephone_number": "947-224-0379",
            "fax_number": "947-941-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "TERRELL",
        "middle_name": "TYRAY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-16",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer D Elkins, R.D.
• Jessica Ellard, LMSW
• Myranda Ellingsen
• Irice Ellis-Crenshaw, RDH
• Patricia A Ellis
• Andre Ellison
• Francine Ellison, NP
• Leonard Eugene Ellison Jr., MD
• Rayford Ellison, PT
• Jamel Ellsberry

• In Home Supportive Care Agency in Southfield, MI
• Providers in Southfield, MI by specialty
• In Home Supportive Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.