1356339006 NPI number — ELIM HOMES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356339006 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:
Provider Other Organization Name Type Code:
6
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:
1356339006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 JEFFERSON AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55388-9250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-955-2691
Provider Business Mailing Address Fax Number:
952-955-3799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 JEFFERSON AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55388-9250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-955-2691
Provider Business Practice Location Address Fax Number:
952-955-3799
Provider Enumeration Date:
10/07/2005

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: 314000000X , with the licence number:  328427 , 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: 328427 . This is a "MINNESOTA STATE LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 816740100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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