Healthcare Provider Details

I. General information

NPI: 1669216826
Provider Name (Legal Business Name): ELMCROFT CONGREGATE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14003 ELMCROFT AVE
NORWALK CA
90650-3713
US

IV. Provider business mailing address

14003 ELMCROFT AVE
NORWALK CA
90650-3713
US

V. Phone/Fax

Practice location:
  • Phone: 626-494-2899
  • Fax: 310-496-1830
Mailing address:
  • Phone: 626-494-2899
  • Fax: 310-496-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS MARTIR
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-474-1130