Provider Demographics
NPI: | 1467891515 |
---|---|
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: | |
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: | 3653 WREN AVE |
Practice Address - Street 2: | |
Practice Address - City: | CONCORD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94519-1767 |
Practice Address - Country: | US |
Practice Address - Phone: | 925-689-8513 |
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
State | License ID | Taxonomies |
---|---|---|
CA | 075600223 | 311Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 311Z00000X | Nursing & Custodial Care Facilities | Custodial Care Facility |