=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063025021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIXIR HOME HEALTH CARE & HOSPICE,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2020
-----------------------------------------------------
Last Update Date | 08/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1935 G ST
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95354-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-369-5110
-----------------------------------------------------
Fax | 209-369-5130
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1935 G ST
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95354-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-369-5110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WARREN DELFIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-581-1359
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------