Provider Demographics
NPI:1538591474
Name:ELPIDA HOUSE, INC.
Entity type:Organization
Organization Name:ELPIDA HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-499-8613
Mailing Address - Street 1:7 MOUNT LASSEN DR STE C257
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1154
Mailing Address - Country:US
Mailing Address - Phone:415-499-8613
Mailing Address - Fax:415-499-8620
Practice Address - Street 1:7 MOUNT LASSEN DR STE C257
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1154
Practice Address - Country:US
Practice Address - Phone:415-499-8613
Practice Address - Fax:415-499-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness