Provider Demographics
NPI:1306959846
Name:ELMS SANITARIUM INC
Entity type:Organization
Organization Name:ELMS SANITARIUM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-240-6720
Mailing Address - Street 1:212 W CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2318
Mailing Address - Country:US
Mailing Address - Phone:818-240-6720
Mailing Address - Fax:818-247-3942
Practice Address - Street 1:212 W CHEVY CHASE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2318
Practice Address - Country:US
Practice Address - Phone:818-240-6720
Practice Address - Fax:818-247-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55605FMedicaid
CALTC55605FMedicaid