MEDICARE: ELAN ACADEMIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY22346	CA

General Provider Information

NPI Number	:	1205226891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELAN ACADEMIES

Provider Business Mailing Address
First Line	:	3158 RED HILL AVE STE 150
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-3428
Country	:	US
Telephone Number	:	714-966-2312
Fax Number	:	714-966-2317

Provider Business Practice Location Address
First Line	:	3158 RED HILL AVE STE 150
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-3428
Country	:	US
Telephone Number	:	714-966-2312
Fax Number	:	714-966-2317

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. MIMA RANSOM
Credential	:
Telephone Number	:	714-966-2312

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

Similar Medicare Providers

1821496282 — ELAN ACADEMIES INC
Practice Location Address:

3158 RED HILL AVE STE 150
COSTA MESA, CA
92626-3428

Practice Phone: 714-966-2312
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1588363824 — A. BARRETT ACADEMY LLC
Practice Location Address:

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Practice Fax:

1083549703 — BRANDON TSAI
Practice Location Address:

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1124953765 — SHANNON MA
Practice Location Address:

3186 AIRWAY AVE STE A
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Directions to “ELAN ACADEMIES ” Practice Location

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