Basic Information
| Provider Information | |||||||||
| NPI: | 1912916198 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALZHEIMER'S LIVING CENTER AT ELIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6276 N 1ST ST | ||||||||
| Address2: | SUITE 103B | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937105400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594381858 | ||||||||
| FaxNumber: | 5592611065 | ||||||||
| Practice Location | |||||||||
| Address1: | 668 E BULLARD AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937105401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593202281 | ||||||||
| FaxNumber: | 5593202292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOWE | ||||||||
| AuthorizedOfficialFirstName: | R. | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5594381858 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZR18205H | 05 | CA | MEDICAID |