1881682680 NPI number — ELIM HOMES, INC.

Table of content: (NPI 1881682680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881682680 NPI number — ELIM HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIM HOMES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELIM OASIS ADULT DAY HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881682680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55371-1713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-389-1171
Provider Business Mailing Address Fax Number:
763-389-0432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55371-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-389-1171
Provider Business Practice Location Address Fax Number:
763-389-0432
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STADTHERR
Authorized Official First Name:
SEELOCHANI
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
952-855-5041

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 328424 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 328424 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 615342900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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