Provider Demographics
NPI:1215075510
Name:MARCELLA ELLIS LLC
Entity type:Organization
Organization Name:MARCELLA ELLIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-760-2999
Mailing Address - Street 1:2 CRAIN HWY S
Mailing Address - Street 2:A
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3526
Mailing Address - Country:US
Mailing Address - Phone:410-760-2999
Mailing Address - Fax:
Practice Address - Street 1:2 CRAIN HWY S
Practice Address - Street 2:A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3526
Practice Address - Country:US
Practice Address - Phone:410-760-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD417482332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment