Healthcare Provider Details

I. General information

NPI: 1528304490
Provider Name (Legal Business Name): ELIM HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EVANS AVE NW
ELK RIVER MN
55330-2604
US

IV. Provider business mailing address

200 LEWIS AVE S SUITE 210
WATERTOWN MN
55388-4545
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-2242
  • Fax: 952-955-2010
Mailing address:
  • Phone: 952-955-2242
  • Fax: 952-955-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number101944
License Number StateMN

VIII. Authorized Official

Name: MR. JEFF DAGEN
Title or Position: OFFICE MANAGER
Credential: RPT
Phone: 952-955-2242