Provider Demographics
NPI:1235328337
Name:ELEKARIM RESIDENTIAL CARE HOME
Entity Type:Organization
Organization Name:ELEKARIM RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:BAINDU
Authorized Official - Last Name:ALLIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-983-8093
Mailing Address - Street 1:1785 HENRY LONG BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6376
Mailing Address - Country:US
Mailing Address - Phone:209-983-8093
Mailing Address - Fax:209-323-5504
Practice Address - Street 1:1785 HENRY LONG BLVD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-6376
Practice Address - Country:US
Practice Address - Phone:209-983-8093
Practice Address - Fax:209-323-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities