Provider Demographics
NPI:1174843460
Name:ELLA, INC.
Entity Type:Organization
Organization Name:ELLA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:VIDETTE
Authorized Official - Last Name:BECKETT-HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-460-1312
Mailing Address - Street 1:2511 E 46TH ST
Mailing Address - Street 2:SUITE N4
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2460
Mailing Address - Country:US
Mailing Address - Phone:317-542-1473
Mailing Address - Fax:317-542-1602
Practice Address - Street 1:2511 E 46TH ST
Practice Address - Street 2:SUITE N4
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2460
Practice Address - Country:US
Practice Address - Phone:317-542-1473
Practice Address - Fax:317-542-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005683A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200936060AMedicaid