Healthcare Provider Details

I. General information

NPI: 1306795844
Provider Name (Legal Business Name): EL ELOHIM HOME CARE LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 CITADEL DR E STE 290-16
COLORADO SPRINGS CO
80909-5314
US

IV. Provider business mailing address

685 CITADEL DR E STE 290-16
COLORADO SPRINGS CO
80909-5314
US

V. Phone/Fax

Practice location:
  • Phone: 651-434-3829
  • Fax:
Mailing address:
  • Phone: 651-434-3829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NATHALIE S KANGMANI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 651-434-3829