Provider Demographics
NPI:1467001230
Name:ELIJAH HOUSE, LOS MOLINOS
Entity Type:Organization
Organization Name:ELIJAH HOUSE, LOS MOLINOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-868-7091
Mailing Address - Street 1:2167 MONTGOMERY ST STE A
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-4945
Mailing Address - Country:US
Mailing Address - Phone:530-868-7091
Mailing Address - Fax:530-854-4118
Practice Address - Street 1:7904 HWY 99E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966
Practice Address - Country:US
Practice Address - Phone:530-854-4119
Practice Address - Fax:530-854-4118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIJAH HOUSE S.L.E
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility