Elm Park, Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

960001105 Issued in CA

Legal business name

ELM PARK, INC

Doing business as

Elm Park

Practice address

4300 Los Flores Blvd
Lynwood, CA 90262-2927

Phone

(310) 638-6691

NPI assigned

Feb 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katherine Lance, MHA

Title

Ceo

Phone

(310) 638-6691

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elm Park Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G684

Legal name

ELM PARK, INC

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jan 20, 2012

Last certification

Nov 13, 2019

Beds

6

Ownership / control type

Private (proprietary)

Facility address

4300 Los Flores Blvd
Lynwood, CA 90262

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378857600000",
    "number": "1215076062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3351 E IMPERIAL HWY",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902623305",
            "telephone_number": "310-638-6691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 LOS FLORES BLVD",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622927",
            "telephone_number": "310-638-6691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELM PARK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2013-09-11",
        "status": "A",
        "authorized_official_last_name": "LANCE",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-638-6691",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "960001105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60909F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elm Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual Disabilities Intermediate Care Facility in Lynwood, CA
• Providers in Lynwood, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.