Provider Demographics
NPI:1093866527
Name:ELAN SENIOR LIVING DBA THE LIVING CENTER
Entity Type:Organization
Organization Name:ELAN SENIOR LIVING DBA THE LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALEN
Authorized Official - Last Name:PAULY
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:209-892-3487
Mailing Address - Street 1:PO BOX 1626
Mailing Address - Street 2:821 E ST.
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-1626
Mailing Address - Country:US
Mailing Address - Phone:209-892-3487
Mailing Address - Fax:209-892-1387
Practice Address - Street 1:821 E ST
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-2670
Practice Address - Country:US
Practice Address - Phone:209-892-3487
Practice Address - Fax:209-892-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500013AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA004929OtherPROVIDER NUMBER