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General NPI Number Information
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NPI Number | 1780203802
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Entity Type | Organization
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Legal Business Name | ELIJAH HOUSE FOUNDATION
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 2060 PARK AVE
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City | OROVILLE
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State | CA
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Zip | 95966-5350
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Country | US
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Telephone | 530-815-9558
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Fax |
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Provider Business Mailing Address
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Address Line | 2060 PARK AVE
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City | OROVILLE
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State | CA
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Zip | 95966-5350
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Country | US
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Telephone | 530-815-9558
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Fax |
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Authorized Official
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Title or Position | CFO/HUMAN RESOURCE MANAGER
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Name | AMANDA BALZLI
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Credential |
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Telephone | 530-682-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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