Provider Demographics
NPI:1649301292
Name:GERICALLS LLC
Entity type:Organization
Organization Name:GERICALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-271-0688
Mailing Address - Street 1:3250 STARTING GATE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-7937
Mailing Address - Country:US
Mailing Address - Phone:443-271-0688
Mailing Address - Fax:
Practice Address - Street 1:3250 STARTING GATE CT
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-7937
Practice Address - Country:US
Practice Address - Phone:443-271-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR086637363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404250600Medicaid
DCP31948Medicare UPIN
MD404250600Medicaid
MD139MMedicare PIN