ELIJAH HOUSE S.L.E (NPI# 1760942965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760942965 |
| Entity Type | Organization |
| Organization Name | ELIJAH HOUSE S.L.E |
| Practice Address |
40 Coyote Moon Trail Bangor CA 95914 |
| Mailing Address |
Po Box 2456 Oroville CA 95965-2456 |
| Practice Telephone | 5308544119 |
| Practice Fax Number | 5308544118 |
| Mailing Telephone | 5308544119 |
| Mailing Fax Number | 5308544118 |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2019-03-22 |
| Authorized Official Name | MR. JOSEPH NATHANIEL HENDERSON (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 5308687091 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Street Address |
40 COYOTE MOON TRAIL |
| City | BANGOR |
| State | CA |
| Zip Code | 95914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669008876 | New Start Recovery Solutions | Substance Abuse Rehabilitation Facility | 40 Coyote Moon Trail, Bangor, CA 95914 | 2020-03-19 |
| 1861058356 | Michelle Leah Middlekauff | Counselor | 40 Coyote Moon Trail, Bangor, CA 95914 | 2019-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346497799 | Case Management Transportation | Non-emergency Medical Transport (VAN) | 5768 La Porte Road, Bangor, CA 95914 | 2008-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1760096564 | Colby Thomas Toth | Specialist/Technologist | 83 Palmer Rd, Bangor, PA 18013-9204 | 2020-08-31 |
| 1861002750 | Alyssa Paige Oliver | Counselor | 689 Odlin Rd, Bangor, ME 04401-6709 | 2020-08-05 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1073139465 | Jaclyn Kimberly Foraker | Nurse Practitioner | 885 Union St Ste 215, Bangor, ME 04401-3092 | 2020-06-22 |
| 1124644950 | Robert Thibeault Brookings | Dentist | 39 Grove Street, Bangor, ME 04401-5309 | 2020-06-17 |
| 1548884323 | A&m Home Care Corp | Technician | 84 Hammond St Ste 441, Bangor, ME 04401-4915 | 2020-06-08 |
| 1083237051 | Twin Doves I LLC | Community Based Residential Treatment Facility, Mental Illness | 48617 36th Ave., Bangor, MI 49013 | 2020-05-25 |
| 1619590247 | Meghan Chenausky | Nurse Practitioner | Pchcenter, 1012 Union Street, Bangor, ME 04401-3060 | 2020-05-18 |
| 1528680261 | Adam Ketchum | Technician | 56 Smith St Apt 2, Bangor, ME 04401-4715 | 2020-05-16 |
| Find all providers in BANGOR | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275723371 | Outpatient Chemical Dependency Agency | Substance Abuse Rehabilitation Facility | 185 Harlow St, Bangor, ME 04401-9101 | 2007-07-26 |
| 1669008876 | New Start Recovery Solutions | Substance Abuse Rehabilitation Facility | 40 Coyote Moon Trail, Bangor, CA 95914 | 2020-03-19 |
| 1508254699 | Wellspring, Inc. | Substance Abuse Rehabilitation Facility | 98 Cumberland St, Bangor, ME 04401-5234 | 2014-12-26 |
| 1205273786 | Manna Inc. | Substance Abuse Rehabilitation Facility | 629 Main St, Bangor, ME 04401-6848 | 2013-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497359 | California Care Detox & Treatment | Substance Abuse Rehabilitation Facility | 25542 Dana Mesa Dr, San Juan Capistrano, CA 92675-4311 | 2020-11-02 |
| 1952900797 | A Sacred Path | Substance Abuse Rehabilitation Facility | 5671 Spanish Flat Rd, Garden Valley, CA 95633 | 2020-10-22 |
| 1467051672 | Spearhead Health Centers, LLC. | Substance Abuse Rehabilitation Facility | 11704 Wilshire Blvd Ste 226, Los Angeles, CA 90025-1504 | 2020-10-19 |
| 1073111613 | A Place To Heal | Substance Abuse Rehabilitation Facility | 14540 Hamlin St Ste H, Van Nuys, CA 91411-4153 | 2020-10-15 |
| 1871191569 | Old Oak Ranch Recovery Center | Substance Abuse Rehabilitation Facility | 19401 Susan Way, Sonora, CA 95370-9266 | 2020-10-14 |
| 1962009845 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 9952 Grandview Dr, La Mesa, CA 91941-6874 | 2020-10-05 |
| 1376140384 | Magic House Recovery Inc | Substance Abuse Rehabilitation Facility | 1001 S Mountvale Ct, Anaheim, CA 92808-2108 | 2020-10-02 |
| 1942807060 | New Perceptions North, LLC | Substance Abuse Rehabilitation Facility | 5084 N Fruit Ave Ste 105, Fresno, CA 93711-3000 | 2020-10-01 |
| 1346857679 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 3480 Hidden Trail Dr, Jamul, CA 91935-2104 | 2020-09-30 |
| 1992312227 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 2810 Camino Del Rio S Ste 106, San Diego, CA 92108-3819 | 2020-09-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.