Provider Demographics
NPI:1477741528
Name:ELAN SENIOR LIVING
Entity Type:Organization
Organization Name:ELAN SENIOR LIVING
Other - Org Name:THE LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-892-3487
Mailing Address - Street 1:1717 COFFEE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2808
Mailing Address - Country:US
Mailing Address - Phone:209-577-6945
Mailing Address - Fax:209-577-5674
Practice Address - Street 1:1717 COFFEE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2808
Practice Address - Country:US
Practice Address - Phone:209-577-6945
Practice Address - Fax:209-577-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500013 CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility