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General NPI Number Information
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NPI Number | 1538591474
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Entity Type | Organization
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Legal Business Name | ELPIDA HOUSE, INC.
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 7 MOUNT LASSEN DR STE C257
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1154
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Country | US
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Telephone | 415-499-8613
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Fax | 415-499-8620
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Provider Business Mailing Address
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Address Line | 7 MOUNT LASSEN DR STE C257
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1154
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Country | US
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Telephone | 415-499-8613
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Fax | 415-499-8620
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Authorized Official
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Title or Position | EXECUTIVE & CLINICAL DIRECTOR
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Name | LAURA MCCORMICK
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Credential |
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Telephone | 415-499-8613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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