Provider Demographics
NPI:1902781073
Name:ELLIS, LEKESA ANGELICA (HHA)
Entity type:Individual
Prefix:MISS
First Name:LEKESA
Middle Name:ANGELICA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 CLYDE PL SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-2129
Mailing Address - Country:US
Mailing Address - Phone:216-338-7280
Mailing Address - Fax:
Practice Address - Street 1:2610 CLYDE PL SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-2129
Practice Address - Country:US
Practice Address - Phone:216-338-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide