BEVERLY DIANE ELLIS (NPI# 1639316912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639316912 |
| Entity Type | Organization |
| Organization Name | BEVERLY DIANE ELLIS |
| Practice Address |
420 Tierney Rd Fort Worth TX 76112-6324 |
| Practice Telephone | 8175345480 |
| Practice Fax Number | 8175344748 |
| Mailing Telephone | 8175345480 |
| Mailing Fax Number | 8175344748 |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2009-01-08 |
| Authorized Official Name | BEVERLY ELLIS (CEO) |
| Authorized Official Telephone | 8175345480 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
420 TIERNEY RD |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76112-6324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841400132 | Eddie Ellis | Counselor | 420 Tierney Rd, Fort Worth, TX 76112-6324 | 2007-05-23 |
| 1932346210 | Eddie Ellis Junior Hcs | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 420 Tierney Rd, Fort Worth, TX 76112-6324 | 2009-01-08 |
| 1316184690 | Blessed Beginings | Clinic/Center | 420 Tierney Rd, Fort Worth, TX 76112-6324 | 2009-01-08 |
| 1902043276 | Beautiful Beginnings | Assisted Living Facility | 420 Tierney Rd, Fort Worth, TX 76112-6324 | 2009-01-08 |
| 1376754366 | Doris Gail Benjamin | Counselor | 420 Tierney Rd, Fort Worth, TX 76112-6324 | 2007-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396211397 | Shelia Minor | Home Health Aide | 5648 Victoria Place, Fort Worth, TX 76112 | 2018-10-17 |
| 1457833816 | Joanne Medford | Physical Therapy Assistant | 1704 Wilson Rd, Fort Worth, TX 76112 | 2018-09-02 |
| 1821525502 | Kids & Hugs Home Therapy | Home Health | 2317 Maryel Dr., Fort Worth, TX 76112 | 2017-05-12 |
| 1932516846 | Neuroassessment Services LLC | Clinical Neuropsychologist | 5601 Bridge Street, Suite 500, Ft. Worth, TX 76112 | 2014-07-14 |
| 1114346335 | Blessed Beginnings | Day Training, Developmentally Disabled Services | 2320 Blue Smoke Court North, Fort Worth, TX 76112 | 2014-04-15 |
| 1790035517 | Transitions for Success Inc | In Home Supportive Care | 6228 Warrington Pl Ace, Fort Worth, TX 76112 | 2012-09-19 |
| 1194048116 | Jerlene Bonner Tippett | Home Health Aide | 1701 Bunch Dr, Ft Worth, TX 76112 | 2010-03-04 |
| 1396076543 | Roy Kenji Yamada | Emergency Medicine | 5800 Forest Bend Pl., Ft. Worth, TX 76112 | 2010-01-27 |
| 1437488228 | Rose A Miller | Case Manager/Care Coordinator | 7312 Laurie Drive, Ft. Worth, TX 76112 | 2009-12-08 |
| 1174760508 | Advocate Angels | Case Management | 6829 Gary Lane, Fort Worth, TX 76112 | 2009-01-07 |
| Find all providers in zip 76112 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518573609 | Jbk House of Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2624 Grand Gulf Rd, Fort Worth, TX 76123-2613 | 2020-09-23 |
| 1770105678 | Regina Renee Edwards | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3841 Irish Setter Dr, Fort Worth, TX 76123-2596 | 2020-05-13 |
| 1003371444 | Azarian Manor LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10325 Pleasant Mound Dr, Fort Worth, TX 76108-4927 | 2019-02-08 |
| 1427405083 | Ablecare Group Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2533 Mill Springs Pass, Fort Worth, TX 76123-2615 | 2016-05-24 |
| 1972849594 | 1 Amazing Family, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4017 Winter Springs Dr, Fort Worth, TX 76123-3410 | 2012-12-31 |
| 1861767493 | Ricky's Hcs Place, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12001 Walden Wood Dr, Fort Worth, TX 76244-5571 | 2012-03-15 |
| 1568747517 | Opportunities Residential Services, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4708 Ardenwood Dr., Fort Worth, TX 76123 | 2011-10-20 |
| 1730479973 | An Open Door Group Home, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7840 Whitney Ln, Fort Worth, TX 76112-6168 | 2011-04-08 |
| 1760771323 | A Family Care Residential Services, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3109 Prairie Ave, Fort Worth, TX 76106-5473 | 2011-04-05 |
| 1871896696 | Cisneros Real Estate Solutions, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2727 S Adams St, Fort Worth, TX 76110-3104 | 2010-12-16 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76112 |
Please comment or provide details below to improve the information on BEVERLY DIANE ELLIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.