Healthcare Provider Details

I. General information

NPI: 1689210635
Provider Name (Legal Business Name): ELSELIA HOME HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14096 GADWALL LN
ROGERS MN
55374-8769
US

IV. Provider business mailing address

14096 GADWALL LN
ROGERS MN
55374-8769
US

V. Phone/Fax

Practice location:
  • Phone: 763-957-2560
  • Fax:
Mailing address:
  • Phone: 763-957-2560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIJAH Z YARPAH
Title or Position: OWNER/MANAGER
Credential:
Phone: 763-957-2560