Healthcare Provider Details

I. General information

NPI: 1043923329
Provider Name (Legal Business Name): ELM INVESTMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 N JACKSON ST
SALEM MO
65560-1076
US

IV. Provider business mailing address

PO BOX 191
MOUNTAIN GROVE MO
65711-0191
US

V. Phone/Fax

Practice location:
  • Phone: 417-425-3062
  • Fax:
Mailing address:
  • Phone: 417-425-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BROOKE M BIGHAM
Title or Position: MANAGER
Credential:
Phone: 417-425-3062