Organization
ELLENBOGEN HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDITH AVANZADO (LICENSEE)
(818) 352-9277
Entity
Organization
Contact information
Practice address
7843 ELLENBOGEN ST, SUNLAND, CA 91040-2213
(818) 352-9277
(626) 793-9847
Mailing address
1802 N MADISON AVE, PASADENA, CA 91104-1236
(818) 352-9277
(626) 793-9847
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Enumeration date
05/19/2007
Last updated
08/22/2020
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