Provider Demographics
NPI:1437298676
Name:ELAN SENIOR LIVING DBA THE LIVING CENTER
Entity Type:Organization
Organization Name:ELAN SENIOR LIVING DBA THE LIVING CENTER
Other - Org Name:THE LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:209-664-9292
Mailing Address - Street 1:2101 GEER RD STE 304-G
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2471
Mailing Address - Country:US
Mailing Address - Phone:209-664-9292
Mailing Address - Fax:209-664-9294
Practice Address - Street 1:2101 GEER RD STE 304-G
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2471
Practice Address - Country:US
Practice Address - Phone:209-664-9292
Practice Address - Fax:209-664-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500013DP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA004929OtherPROVIDER NUMBER