Healthcare Provider Details

I. General information

NPI: 1659299097
Provider Name (Legal Business Name): MARY ELLA HOMES & PROVIDER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 WALL ST
TOLEDO OH
43610-1284
US

IV. Provider business mailing address

2111 DORR ST
TOLEDO OH
43607-3743
US

V. Phone/Fax

Practice location:
  • Phone: 419-245-8742
  • Fax:
Mailing address:
  • Phone: 419-245-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: SHALONDA EZELL
Title or Position: OWNER/CEO
Credential:
Phone: 419-245-8742