| Doctor Name: | AMANDA ELLIS |
| NPI Number: | 1194198697 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | D05686544 |
| Business Practice Address: | 381 East Brook Street San Tan Valley, AZ - 85140 |
| Business Phone Number: | 4804952839 |
| Business Fax Number: | |
| Mailing Address: | 381 E Brook St, SAN TAN VALLEY |
| State: | AZ |
| Postal Code: | 85140 |
| Phone Number: | 4804952839 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2015 |
| NPI Last Update Date: | 11/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | D05686544 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |