MEDICARE: ELMIRA RECUPERATIVE CARE LLC

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	177F00000X	Lodging Provider

General Provider Information

NPI Number	:	1407651169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELMIRA RECUPERATIVE CARE LLC

Provider Business Mailing Address
First Line	:	116 E BROADWAY STE 202
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1093
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 E BROADWAY STE 202
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1093
Country	:	US
Telephone Number	:	818-823-7991
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. EMIL AGHAKIAN
Credential	:
Telephone Number	:	888-683-6608

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	04/25/2026

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