Organization
ELAINES RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW OHIMAI OJO (ADMINISTRATOR)
(928) 247-2804
Entity
Organization
Contact information
Practice address
1773 E CARDINAL DR, CASA GRANDE, AZ 85122-6317
(716) 370-5678
Mailing address
1773 E CARDINAL DR, CASA GRANDE, AZ 85122-6317
(480) 330-4541
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
376G00000X
Nursing Home Administrator
—
—
Other
Enumeration date
07/21/2020
Last updated
12/21/2021
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