Provider Demographics
NPI:1780203802
Name:ELIJAH HOUSE FOUNDATION
Entity type:Organization
Organization Name:ELIJAH HOUSE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/HUMAN RESOURCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALZLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-682-0266
Mailing Address - Street 1:2060 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5350
Mailing Address - Country:US
Mailing Address - Phone:530-815-9558
Mailing Address - Fax:
Practice Address - Street 1:2060 PARK AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5350
Practice Address - Country:US
Practice Address - Phone:530-815-9558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIJAH HOUSE SLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-09
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health