Healthcare Provider Details

I. General information

NPI: 1225830805
Provider Name (Legal Business Name): ELM CREEK HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W END BLVD STE 100
ST LOUIS PARK MN
55416-5369
US

IV. Provider business mailing address

1650 W END BLVD STE 100
ST LOUIS PARK MN
55416-5369
US

V. Phone/Fax

Practice location:
  • Phone: 612-305-8260
  • Fax: 763-207-1377
Mailing address:
  • Phone: 612-305-8260
  • Fax: 763-207-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALISON WILLIAMS
Title or Position: EXECUTIVE
Credential:
Phone: 612-305-8260