MR. DARRELL LEMONT ELLIS JR. (NPI# 1174925424) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174925424 |
| Entity Type | Individual |
| Full Name | MR. DARRELL LEMONT ELLIS JR. |
| Credential | ADMINISTRATOR |
| Practice Address |
304 N Lincoln Ave Casa Grande AZ 85122-4634 |
| Mailing Address |
304 N. Lincoln Ave Casa Grande AZ 85122 |
| Practice Telephone | 4805608924 |
| Mailing Telephone | 4805608924 |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-09-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | BH-4483 | AZ | Residential Treatment Facilities |
| Street Address |
304 N LINCOLN AVE |
| City | CASA GRANDE |
| State | AZ |
| Zip Code | 85122-4634 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235532060 | Successful Livings LLC | Residential Treatment Facility, Emotionally Disturbed Children | 304 N Lincoln Ave, Casa Grande, AZ 85122-4634 | 2014-10-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043857097 | Karen M Garcia | Registered Nurse | 2631 N Brown Avenue, Casa Grande, AZ 85122 | 2019-12-09 |
| 1063060291 | Martha Bollin | Registered Nurse | 2631 N. Brown Ave., Casa Grande, AZ 85122 | 2019-08-30 |
| 1841846920 | Banner Imaging Services LLC | Radiology | 1828 E. Florence Blvd Bldg B Ste 118 & 128, Suite 118 and 128, Casa Grande, AZ 85122 | 2019-08-14 |
| 1629532692 | Kirk Lee Mackley | Physical Therapist | Vibrant Care, 1355 E Florence Blvd #137, Casa Grande, AZ 85122 | 2019-01-24 |
| 1205307436 | Natalie T Trujillo | Physician Assistant | 301 E Cottonwood Ln Ste 1&2, Casa Grande, AZ 85122 | 2018-12-16 |
| 1710455860 | Community Intervention Associates, Inc | Clinic/Center | 1667 N. Trekell Rd, Suite 101 & 102, Casa Grande, AZ 85122 | 2018-11-07 |
| 1245728302 | Jenkins Chiropractic LLC | Chiropractor | 1891 N Trekell Rd Ste 2, Casa Grande, AZ 85122 | 2018-04-24 |
| 1497242408 | Kelly Winnett | Naturopath | 1415 N Trekell Rd Ste 102, Casa Grande, AZ 85122 | 2018-04-16 |
| 1851895783 | Michael Brubaker Counseling | Community/Behavioral Health | 1927 N. Trekell Rd, Ste D, Casa Grande, AZ 85122 | 2018-03-23 |
| 1770095317 | Walmart Stores Inc. | Pharmacy | 1741 E. Florence Blvd, Casa Grande, AZ 85122 | 2017-11-03 |
| Find all providers in zip 85122 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073158846 | Kewala Corporations | Community Based Residential Treatment Facility, Mental Illness | 556 W Mirage Loop, Casa Grande, AZ 85122-6133 | 2019-11-15 |
| 1417323122 | Serenity Health Care | Community Based Residential Treatment Facility, Mental Illness | 1106 N Pinal Ave, Casa Grande, AZ 85122-3302 | 2015-08-17 |
| 1528474533 | Mary Flanery | Community Based Residential Treatment Facility, Mental Illness | 1365 E 12th St, Casa Grande, AZ 85122-3694 | 2014-07-10 |
| 1598025934 | House of Hope | Community Based Residential Treatment Facility, Mental Illness | 1149 E 11th St, Casa Grande, AZ 85122-3609 | 2012-05-18 |
| 1740419670 | The Chalet House LLC | Community Based Residential Treatment Facility, Mental Illness | 2557 N Lupita Pl, Casa Grande, AZ 85222-1036 | 2009-07-14 |
| 1790842755 | Mentor Healthcare, Inc | Community Based Residential Treatment Facility, Mental Illness | 621 W Racine Loop, Casa Grande, AZ 85222-5111 | 2007-01-02 |
| 1841356003 | Mentor Healthcare, Inc | Community Based Residential Treatment Facility, Mental Illness | 1668 E Melissa St, Casa Grande, AZ 85222-4742 | 2006-12-29 |
| 1427114743 | Mentor Healthcare, Inc | Community Based Residential Treatment Facility, Mental Illness | 8428 W. Royal Blackheath, Casa Grande, AZ 85223 | 2006-12-29 |
| 1225192107 | Horizon Health and Wellness, Inc. | Community Based Residential Treatment Facility, Mental Illness | 2269 S Peart Rd, Casa Grande, AZ 85222 | 2006-12-21 |
| 1396195939 | House of Hope Behavioral Health LLC | Community Based Residential Treatment Facility, Mental Illness | 1149 E 11th St, Casa Grande, AZ 85122-3609 | 2016-06-14 |
| Find all providers in CASA GRANDE | ||||
| City | CASA GRANDE |
| Zip Code | 85122 |
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| 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.