Provider Demographics
NPI:1740075167
Name:MENSAH, ELLEN
Entity type:Individual
Prefix:MISS
First Name:ELLEN
Middle Name:
Last Name:MENSAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 AMEGA WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8787
Mailing Address - Country:US
Mailing Address - Phone:646-238-4603
Mailing Address - Fax:
Practice Address - Street 1:7400 AMEGA WAY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8787
Practice Address - Country:US
Practice Address - Phone:646-238-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-01610251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRSA-01610OtherRESIDENTIAL SERVICE AGENCY NON EXPIRING LICENSE