Healthcare Provider Details

I. General information

NPI: 1407651169
Provider Name (Legal Business Name): ELMIRA RECUPERATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E BROADWAY STE 202
GLENDALE CA
91205-1093
US

IV. Provider business mailing address

116 E BROADWAY STE 202
GLENDALE CA
91205-1093
US

V. Phone/Fax

Practice location:
  • Phone: 818-823-7991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: MR. EMIL AGHAKIAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 888-683-6608