Provider Demographics
NPI:1316386451
Name:ELIM SENIOR SERVICES LLC
Entity Type:Organization
Organization Name:ELIM SENIOR SERVICES LLC
Other - Org Name:ELIM ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ECATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TET
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:925-768-3031
Mailing Address - Street 1:18787 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2905
Mailing Address - Country:US
Mailing Address - Phone:888-818-8101
Mailing Address - Fax:
Practice Address - Street 1:5126 CORAL CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2315
Practice Address - Country:US
Practice Address - Phone:925-689-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA075601505311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility