Organization
ELIAA LLC #2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AHMED QASIM (ADMIN)
(650) 452-2554
Entity
Organization
Contact information
Practice address
17520 BROWN ST, PERRIS, CA 92570-9110
(650) 452-2554
Mailing address
17520 BROWN ST, PERRIS, CA 92570-9110
(650) 452-2554
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
331881239
CDSS LICENSE
CA
Enumeration date
05/02/2022
Last updated
05/04/2022
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