Provider Demographics
NPI:1578014437
Name:ELSA'S ADULT CARE HOME, LLC
Entity Type:Organization
Organization Name:ELSA'S ADULT CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:IYOYO
Authorized Official - Last Name:GATCHALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-886-8283
Mailing Address - Street 1:6301 E CALLE DE SAN ALBERTO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2113
Mailing Address - Country:US
Mailing Address - Phone:520-886-8283
Mailing Address - Fax:820-886-2848
Practice Address - Street 1:6301 E CALLE DE SAN ALBERTO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2113
Practice Address - Country:US
Practice Address - Phone:520-886-8283
Practice Address - Fax:820-886-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL6219H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ223427OtherAHCCCS