Organization
ELAN SENIOR LIVING
Active
Other names
The Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROD M NEWHALL (PROGRAM DIRECTOR)
(209) 477-0265
Entity
Organization
Contact information
Practice address
4410 N PERSHING AVE, SUITE C-1, STOCKTON, CA 95207-6900
(209) 477-0265
(209) 477-0292
Mailing address
4410 N PERSING, SUITE C-1, STOCKTON, CA 95204-4404
(209) 477-0265
(209) 477-0292
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004929
OTHER
CA
Enumeration date
05/07/2007
Last updated
08/22/2020
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