Provider Demographics
NPI:1225241433
Name:ELAN SENIOR LIVING
Entity Type:Organization
Organization Name:ELAN SENIOR LIVING
Other - Org Name:THE LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-477-0265
Mailing Address - Street 1:4410 N PERSING
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-4404
Mailing Address - Country:US
Mailing Address - Phone:209-477-0265
Mailing Address - Fax:209-477-0292
Practice Address - Street 1:4410 N PERSHING AVE
Practice Address - Street 2:SUITE C-1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6900
Practice Address - Country:US
Practice Address - Phone:209-477-0265
Practice Address - Fax:209-477-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA004929OtherOTHER