Provider Demographics
NPI:1407375397
Name:ELEMENTAL TREATMENT LLC
Entity Type:Organization
Organization Name:ELEMENTAL TREATMENT LLC
Other - Org Name:SOLID GROUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-774-1303
Mailing Address - Street 1:1976 S LA CIENEGA BLVD STE 668
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1627
Mailing Address - Country:US
Mailing Address - Phone:310-774-1303
Mailing Address - Fax:
Practice Address - Street 1:6860 BROCKTON AVE STE 9
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3816
Practice Address - Country:US
Practice Address - Phone:310-774-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELEMENTAL TREATMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility