MEDICARE: ELITE HOUSING SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320700000X	Physical Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1487005252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HOUSING SERVICES INC

Provider Business Mailing Address
First Line	:	3055 OLD HIGHWAY 8 STE 111
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-2577
Country	:	US
Telephone Number	:	952-406-0267
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 OLD HIGHWAY 8 STE 111
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-2577
Country	:	US
Telephone Number	:	952-406-0267
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABDIWELI HASSSAN HASHI
Credential	:
Telephone Number	:	952-406-0267

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	12/29/2022

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