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General NPI Number Information
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NPI Number | 1477741528
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Entity Type | Organization
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Legal Business Name | ELAN SENIOR LIVING
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 1717 COFFEE RD SUITE A
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City | MODESTO
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State | CA
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Zip | 95355-2808
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Country | US
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Telephone | 209-577-6945
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Fax | 209-577-5674
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Provider Business Mailing Address
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Address Line | 1717 COFFEE RD SUITE A
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City | MODESTO
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State | CA
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Zip | 95355-2808
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Country | US
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Telephone | 209-577-6945
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Fax | 209-577-5674
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. NICOLE DEANNE BLANCHARD
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Credential |
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Telephone | 209-892-3487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 500013 CP
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License Number State | CA
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