Provider Demographics
NPI:1619374899
Name:ELMIRA INC
Entity Type:Organization
Organization Name:ELMIRA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:PEARL
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-459-6424
Mailing Address - Street 1:25855 CARLYSLE ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-2604
Mailing Address - Country:US
Mailing Address - Phone:734-459-6424
Mailing Address - Fax:734-459-6710
Practice Address - Street 1:25855 CARLYSLE ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2604
Practice Address - Country:US
Practice Address - Phone:734-459-6424
Practice Address - Fax:734-459-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820014194320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities