Organization
ELM PARK, INC
Active
Other names
Elm Park
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE LANCE MHA (CEO)
(310) 638-6691
Entity
Organization
Contact information
Practice address
4300 LOS FLORES BLVD, LYNWOOD, CA 90262-2927
(310) 638-6691
Mailing address
3351 E IMPERIAL HWY, LYNWOOD, CA 90262-3305
(310) 638-6691
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
960001105
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60909F
—
CA
Enumeration date
02/06/2007
Last updated
09/11/2013
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