| Doctor Name: | MRS. KATHLEEN MARIE ELLIS |
| NPI Number: | 1346685575 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPTA |
| License Number: | 5502001225 |
| Business Practice Address: | 512 Beach St Fenton, MI - 484303122 |
| Business Phone Number: | 8106294117 |
| Business Fax Number: | |
| Mailing Address: | 11182 E Richfield Rd, DAVISON |
| State: | MI |
| Postal Code: | 484238517 |
| Phone Number: | 8102529888 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2013 |
| NPI Last Update Date: | 05/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 313M00000X |
| License Number: | 5502001225 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Nursing Facility/Intermediate Care Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |