Provider Demographics
NPI:1245347731
Name:ELYSIAN CARE CORP
Entity type:Organization
Organization Name:ELYSIAN CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-679-3344
Mailing Address - Street 1:15100 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2209
Mailing Address - Country:US
Mailing Address - Phone:310-679-3344
Mailing Address - Fax:714-644-7150
Practice Address - Street 1:15100 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2209
Practice Address - Country:US
Practice Address - Phone:310-679-3344
Practice Address - Fax:714-644-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55816FMedicare ID - Type Unspecified
CA555816Medicare ID - Type Unspecified