MEDICARE: ELLEE RESIDENTIAL CARE #2

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197602998	OTHER	CA	CALIFORNIA DEPARTMENT OF PUBLIC HEALTH

General Provider Information

NPI Number	:	1235750761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEE RESIDENTIAL CARE #2

Provider Business Mailing Address
First Line	:	11323 CALVERT ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4217
Country	:	US
Telephone Number	:	818-980-6040
Fax Number	:	818-980-6040

Provider Business Practice Location Address
First Line	:	11323 CALVERT ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4217
Country	:	US
Telephone Number	:	818-980-6040
Fax Number	:	818-980-6040

Authorized Official
Title or Position	:	LICENSEE
Name	:	MRS. ELEANOR POSNER
Credential	:	RN
Telephone Number	:	818-281-5822

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	05/06/2020

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Directions to “ELLEE RESIDENTIAL CARE #2 ” Practice Location

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