MEDICARE: LEON J ELLINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1619763976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEON J ELLINGTON

Provider Business Mailing Address
First Line	:	3656 CHELTON RD # 58
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5064
Country	:	US
Telephone Number	:	216-412-0594
Fax Number	:

Provider Business Practice Location Address
First Line	:	3656--58 CHELTON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-0001
Country	:	US
Telephone Number	:	216-412-0594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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