Provider Demographics
NPI:1225553985
Name:ELMER PLACE FOR PARENTS
Entity Type:Organization
Organization Name:ELMER PLACE FOR PARENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:NABONG
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-337-4753
Mailing Address - Street 1:25968 N SANDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-6837
Mailing Address - Country:US
Mailing Address - Phone:623-337-4753
Mailing Address - Fax:623-374-6187
Practice Address - Street 1:25968 N.SANDSTONE WAY
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387
Practice Address - Country:US
Practice Address - Phone:623-337-4753
Practice Address - Fax:623-374-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10437H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility