Provider Demographics
NPI:1285288019
Name:ELK BRIDGE HOMES, LLC
Entity type:Organization
Organization Name:ELK BRIDGE HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:602-448-2050
Mailing Address - Street 1:13251 W CHAPAROSA WAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7845
Mailing Address - Country:US
Mailing Address - Phone:602-448-2050
Mailing Address - Fax:
Practice Address - Street 1:13251 W CHAPAROSA WAY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7845
Practice Address - Country:US
Practice Address - Phone:602-448-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities