Provider Demographics
NPI:1740612290
Name:ELSINORE CONSTRUCTION & REMODELING LLC
Entity Type:Organization
Organization Name:ELSINORE CONSTRUCTION & REMODELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DICUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-280-8776
Mailing Address - Street 1:28461 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-6628
Mailing Address - Country:US
Mailing Address - Phone:314-280-8776
Mailing Address - Fax:
Practice Address - Street 1:28461 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-6628
Practice Address - Country:US
Practice Address - Phone:314-280-8776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities