NPIMap

Organization Active NPI

Elaine Ellis Center of Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • College Park, MD
National Provider Identifier
1932710183
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ELAINE ELLIS CENTER OF HEALTH, INC.
Practice address
10001 Rhode Island Ave
College Park, MD 20740-1141
Phone
(301) 441-1605
Fax
(301) 345-1609
NPI assigned
Aug 12, 2020
Last updated
Jul 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Ms. Jacquelyn Renee Walker
Title
Ceo
Phone
(202) 803-2340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

10001 Rhode Island Ave
College Park, MD 20740-1141

Mailing address

1627 Kenilworth Ave NE
Washington, DC 20019-2010
Phone (202) 803-2340

National Provider Directory

National Provider Directory
Tax ID family
Elaine Ellis Center of Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1627 Kenilworth Ave NE
Washington, DC 20019
Phone (202) 803-2340

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1932710183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1627 KENILWORTH AVE NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200192010",
            "telephone_number": "202-803-2340",
            "fax_number": "202-803-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10001 RHODE ISLAND AVE",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207401141",
            "telephone_number": "301-441-1605",
            "fax_number": "301-345-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELAINE ELLIS CENTER OF HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-12",
        "last_updated": "2024-07-17",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "202-803-2340",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in College Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.