Provider Demographics
NPI:1447995717
Name:ELIAA LLC #2
Entity type:Organization
Organization Name:ELIAA LLC #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:QASIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-452-2554
Mailing Address - Street 1:17520 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-9110
Mailing Address - Country:US
Mailing Address - Phone:650-452-2554
Mailing Address - Fax:
Practice Address - Street 1:17520 BROWN ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-9110
Practice Address - Country:US
Practice Address - Phone:650-452-2554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA331881239OtherCDSS LICENSE