Provider Demographics
NPI:1952799702
Name:ELM RIDGE ENTERPRISES, LLC
Entity Type:Organization
Organization Name:ELM RIDGE ENTERPRISES, LLC
Other - Org Name:LINDA MALSBARY, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALSBARY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:254-780-9571
Mailing Address - Street 1:2235 N PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-4613
Mailing Address - Country:US
Mailing Address - Phone:254-780-9571
Mailing Address - Fax:254-780-2195
Practice Address - Street 1:2235 N PEA RIDGE RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-4613
Practice Address - Country:US
Practice Address - Phone:254-780-9571
Practice Address - Fax:254-780-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX362941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176633901Medicaid
TX176633901Medicaid