Provider Demographics
NPI:1912916198
Name:ALZHEIMER'S LIVING CENTER AT ELIM
Entity Type:Organization
Organization Name:ALZHEIMER'S LIVING CENTER AT ELIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-438-1858
Mailing Address - Street 1:6276 N 1ST ST
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5400
Mailing Address - Country:US
Mailing Address - Phone:559-438-1858
Mailing Address - Fax:559-261-1065
Practice Address - Street 1:668 E BULLARD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5401
Practice Address - Country:US
Practice Address - Phone:559-320-2281
Practice Address - Fax:559-320-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
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
CAZZR18205HMedicaid
CAZZR18205HMedicaid